Condom Acquisition, Errors, and Breakage among U.S. Cisgender College Students.

High rates of sexually transmitted infections and unplanned pregnancy continue to plague young adults in the USA with low condom use a contributing factor. To better understand condom acquisition, errors, and breakage among US cisgender college students, a survey was conducted across six structurally diverse institutions of higher education in 2019-2020 prior to the COVID-19 pandemic. Students who had used external condoms in the last year (N = 1584) were asked about specific on- and off-campus locations of condom acquisition and practices related to condom use. Findings indicate that students most frequently acquired condoms off-campus with location differences between genders and relationship status. Condom errors were common, with no consistent patterns related to gender, but unpartnered students were more likely than those in relationships to experience condom errors. Multivariate logistic regression indicated that relationship status, applying condom on wrong side, adding condom after sex started, removing condom during sex, condom slipping off, and problems with fit were predictors for condom breakage. The study results provide guidance for healthcare and sexuality education professionals working with college students to better address the differing needs of college students regarding condom acquisition and correct condom use.

Condoms on Campus: Understanding College Students' Embarrassment, Self-Efficacy, and Beliefs About Distribution Programs.

BACKGROUND: Condom distribution programs are a structural-level intervention implemented on college campuses to reduce sexually transmitted infections and unplanned pregnancies. Understanding students' beliefs about these programs and attitudes that can affect condom use is critical. METHODS: Students at 6 different universities (n = 2809) completed items related to beliefs about campus condom distribution programs and their personal condom embarrassment and condom self-efficacy levels. Surveys were completed both in classroom and online. T Tests and analysis of variance were used to examine differences based on demographics. Logistic regression was used to examine predictors of condom use. RESULTS: College students support the distribution of condoms on campus (97.4%) but express moderate levels of embarrassment in condom acquisition and possession (mean, 19.37). Lower rates of embarrassment were reported for condom negotiation (mean, 9.13) and actual condom use (mean, 8.48). Lower overall rates of embarrassment were reported by condom users, men and individuals in relationships compared with noncondom users, women, and single individuals. Heterosexual students were more embarrassed than bisexual students about acquiring condoms and negotiating condom use. Condom users, men, and individuals in relationships had higher rates of condom self-efficacy compared with nonusers, women, and single students. There were no differences in self-efficacy based on sexual orientation. Embarrassment about acquiring and actual use of condoms, condom self-efficacy and demographics were all significant predictors of condom use. CONCLUSIONS: Campus condom distribution programs are supported by college students. Interventions to address embarrassment and increase condom self-efficacy need to be tailored to different students based on gender, experience with condoms, and relationship status.

Developmental Differences in the Relationships Between Sensorimotor and Executive Functions.

BACKGROUND: There is evidence that sensorimotor and executive functions are inherently intertwined, but that the relationship between these functions differ depending on an individual's stage in development (e.g., childhood, adolescence, adulthood). OBJECTIVE: In this study, sensorimotor and executive function performance was examined in a group of children (n = 40; 8-12 years), adolescents (n = 39; 13-17 years), and young adults (n = 83; 18-24 years) to investigate maturation of these functions, and how the relationships between these functions differ between groups. RESULTS: Adults and adolescents outperformed children on all sensorimotor and executive functions. Adults and adolescents exhibited similar levels of executive functioning, but adults outperformed adolescents on two sensorimotor functioning measures (eye-hand coordination spatial precision and proprioceptive variability). Regression analysis demonstrated that executive functions contribute to children's sensorimotor performance, but do not contribute to adolescent's sensorimotor performance. CONCLUSION: These findings highlight the key role that developmental stage plays in the relationship between sensorimotor and executive functions. Specifically, executive functions appear to contribute to more successful sensorimotor function performance in childhood, but not during adolescence. It is likely that sensorimotor functions begin to develop independently from executive functions during adolescence, and therefore do not contribute to successful sensorimotor performance. The change in the relationship between sensorimotor and executive functions is important to take into consideration when developing sensorimotor and executive function interventions.

Movement Kinematics and Interjoint Coordination Are Influenced by Target Location and Arm in 6-Year-Old Children.

Rapid aiming movements are typically used to study upper limb motor control and development. Despite the large corpus of work in this area, few studies have examined kinematic manual asymmetries in children who have just started formal schooling and until now, none have characterized how children coordinate their joints to complete these movements (i.e., interjoint coordination). In the present study, manual asymmetries in kinematics and interjoint coordination in strongly right-handed 6-year-old children were investigated when reaching for ipsilateral and contralateral targets with their dominant right arm and the non-dominant left arm. Overall, manual asymmetries in interjoint coordination are apparent for both 6-year-old children and young adults, although young children completed the task by adopting a different strategy than adults. Also, control strategies employed by 6-year-old children were influenced by both the location of the target as well as the arm used to perform the task. Specifically, compared to all other conditions, children's trajectories were more curved when performing contralateral movements with the non-dominant left arm, which were driven by smaller shoulder excursions combined with larger elbow excursions for this condition. Based on these results, we argue that the differences in interjoint coordination reflect the stage of development of 6-year-old children, the origin of which derives from maturational (e.g., hand dominance) and environmental factors (e.g., school-based experience).

The Role of Executive Functions for Motor Performance in Preschool Children as Compared to Young Adults.

Evidence suggests that executive and motor functions are functionally intertwined, with the interrelation between the two processes influenced by the developmental stage of the individual. This study examined executive and motor functions in preschool children (n = 41; 65-83 months), and investigated if, and how, preschoolers cognitive-motor functioning differs from that of young adults (n = 40; 18-31 years), who served as a control group reflecting the upper bound of cognitive-motor development. As expected, performance of young adults was significantly better than that of preschool children for all cognitive and motor domains tested. The results further showed differential associations among, and between, cognitive and motor functions in preschool children when compared to young adults. While similar correlations among motor variables are found in both groups, correlations among executive functions and between executive and motor variables are only found in preschool children. It thus appears that executive functions (especially working memory) contribute more to successful motor performance in preschool years than in young adulthood. The findings highlight the importance of considering the developmental stage and/or the proficiency level of the individual when examining cognitive-motor interactions or when drawing implications for childhood cognitive-motor training and interventions.

Changes in Incidents and Payment Methods for Intimate Partner Violence Related Injuries in Women Residing in the United States, 2002 to 2015.

BACKGROUND: Violence in interpersonal relationships is a substantial health and social problem in the United States and is associated with a myriad of immediate and long-term physical, behavioral, and neurocognitive impairments. The present study sought to determine the incidence of U.S. emergency department (ED)-attended intimate partner violence (IPV) from 2002 to 2015 and examine the differences in payment sources before and after implementation of the Affordable Care Act. METHODS: We analyzed ED visits among female patients aged 15 years or older between 2002 and 2015 from the National Hospital Ambulatory Medical Care Survey. Using International Classification of Disease, Ninth Revision, Clinical Modification, codes from patient visit records, we classified each ED visit to determine the frequency and estimate the relative proportion and national frequency of IPV visits. We explored bivariate and multivariate associations between IPV-related injuries with age, race, ethnicity, method of payment, and region, noting changes over time. RESULTS: Between 2002 and 2015, female patients visited EDs an estimated 2,576,417 times for IPV-related events, and the proportion of ED visits for IPV increased during that time period. The percentage of ED visits for IPV-related events did not differ significantly by region, race, or ethnicity. Compared with women 25-44 years of age, women aged 65 to 74 (odds ratio, 0.15; 95% confidence interval, 0.05-0.43; p < .001) and 75 years and older (odds ratio, 0.20; 95% confidence interval, 0.08-0.53; p = .001) were less likely to visit an ED for IPV. Women were more likely to pay for IPV-related services out-of-pocket (i.e., self-pay) (odds ratio, 1.85; 95% confidence interval, 1.24-277; p = .003) before the enactment of the Affordable Care Act. CONCLUSIONS: The increase in the percentage of IPV-related ED claims paid by private insurance suggests that the Affordable Care Act may have increased women's willingness and ability to seek medical attention for IPV-related injuries and disclose IPV as the source of injuries.

Stroke Characteristics and Outcomes of Adult Patients in Northwest Ethiopia.

Stroke is becoming one of the leading causes of adult disability and death in sub-Saharan African countries. The aim of the present study is to provide an up-to-date account of the clinical and demographic characteristics of patients with stroke admitted to the University of Gondar College of Medicine and Health Science Comprehensive Specialized Hospital (CMHS). A hospital based retrospective study design was used to analyze the medical records of all patients with stroke admitted to CMHS from June 20th 2012 and April 30th 2018. Data were cleaned and entered into SPSS for analysis. Among the 448 patients with stroke admitted to CMHS, 58.0% (n = 260) of patients were female, and 42.0% (n = 188) were male. In the present sample, 141 (31.5%) had an ischemic stroke confirmed by neuroimaging, 82 (18.3%) had a hemorrhagic stroke confirmed by neuroimaging, and 252 (50.2%) had a stroke with undetermined type. The mean age of stroke was 63.9 years (range = 18-100, SD: 15.1 years), with no differences observed between stroke subtypes. The most common symptoms that led to patients seeking medical intervention were hemiparesis (67.4%), communication difficulties (56.0%), facial deviation (37.3%), and globalized headache (36.4%). Hypertension was the most commonly reported risk factor (37.1%), which was more prevalent in hemorrhagic (n = 37, 45.1%) than ischemic stroke patients (n = 53, 37.6%), stroke with undetermined type (n = 76, 33.8%). Stroke places a significant burden on sub-Saharan African countries. Results of the current study highlight the need to develop programs that educate the Ethiopian populace about the risk factors and symptoms of stroke, the importance of seeking medical care within the golden window, and the benefits of neuroimaging to accurately diagnose stroke subtype. In addition, the current study provides hospital administrators with empirical data that they can use to form an interdisciplinary stroke rehabilitation team capable of improving outcomes of Ethiopian patients with stroke.

Coupling Robot-Aided Assessment and Surface Electromyography (sEMG) to Evaluate the Effect of Muscle Fatigue on Wrist Position Sense in the Flexion-Extension Plane.

Proprioception is a crucial sensory modality involved in the control and regulation of coordinated movements and in motor learning. However, the extent to which proprioceptive acuity is influenced by local muscle fatigue is obscured by methodological differences in proprioceptive and fatiguing protocols. In this study, we used high resolution kinematic measurements provided by a robotic device, as well as both frequency and time domain analysis of signals captured via surface electromyography (sEMG) to examine the effects of local muscle fatigue on wrist proprioceptive acuity in 16 physically and neurologically healthy young adults. To this end, participants performed a flexion/extension ipsilateral joint position matching test (JPM), after which a high-resistive robotic task was used to induce muscle fatigue of the flexor carpi radialis (FCR) muscle. The JPM test was then repeated in order to analyze potential changes in proprioceptive acuity. Results indicated that the fatigue protocol had a significant effect on movements performed in flexion direction, with participants exhibiting a tendency to undershoot the target before the fatigue protocol (-1.218°), but overshooting after the fatigue protocol (0.587°). In contrast, in the extension direction error bias values were similar before and after the fatigue protocol as expected (pre = -1.852°, post = -1.237°) and reflected a tendency to undershoot the target. Moreover, statistical analysis indicated that movement variability was not influenced by the fatigue protocol or movement direction. In sum, results of the present study demonstrate that an individual's estimation of wrist joint displacement (i.e., error bias), but not precision (i.e., variability), is affected by muscular fatigue in a sample of neurologically and physically healthy adults.

Development of a Post-stroke Upper Limb Rehabilitation Wearable Sensor for Use in Sub-Saharan Africa: A Pilot Validation Study.

The development of context-appropriate sensor technologies could alleviate the significant burden of stroke in Sub-Saharan African rehabilitation clinicians and health care facilities. However, many commercially available wearable sensors are beyond the financial capabilities of the majority of African persons. In this study, we evaluated the concurrent validity of a low-cost wearable sensor (i.e., the outREACH sensor) to measure upper limb movement kinematics of 31 healthy persons, using an 8-camera Vicon motion capture system as the reference standard. The outREACH sensor showed high correlation (r range: 0.808-0.990) and agreement (mean difference range: -1.60 to 1.10) with the reference system regardless of task or kinematic parameter. Moreover, Bland-Altman analyses indicated that there were no significant systematic errors present. This study indicates that upper limb movement kinematics can be accurately measured using the outREACH sensor, and have the potential to enhance stroke evaluation and rehabilitation in sub-Saharan Africa.

Quantitative Assessment of Upper Limb Motor Function in Ethiopian Acquired Brain Injured Patients Using a Low-Cost Wearable Sensor.

Acquired brain injuries place a significant burden on sub-Saharan African rehabilitation clinicians and health care facilities. While wearable sensors have the potential to alleviate these issues, many are beyond the financial capabilities of the majority of African persons and clinics. To bridge this gap, we have developed a low-cost wrist-worn sensor (the outREACH sensor) capable of accurately measuring upper limb movement kinematics. In this study we evaluated the extent to which the outREACH sensor is sensitive to the hand performing the task (unimpaired, impaired) and level of impairment (mild, moderate) in 14 Ethiopian persons with acquired brain injury (mean age = 51.6 ± 12.2 years, 1 female, 13 male). Participants performed an object manipulation task with both the impaired and the unimpaired limb, and reaching performance was measured using standard kinematic measures (i.e., movement time, spectral arc length, peak velocity, peak acceleration, mean velocity, mean acceleration). Overall, movements were smoother and faster when performed by the patient's unimpaired limb. In contrast, maximum velocity did not differ between the two limbs. Moreover, the outREACH sensor was sensitive to differences in performance-based upper limb impairment. Fugl-Meyer assessment for upper extremity scores were significantly correlated with movement time, spectral arc length, and peak velocity. Upper limb movement kinematics can be accurately measured using the outREACH sensor. The outREACH sensor can be a valuable addition to standardized clinical measures that provides rehabilitation clinicians with information regarding initial upper limb impairment level and changes in function across the rehabilitation lifespan.

Age-Related Decline in Anticipatory Motor Planning and Its Relation to Cognitive and Motor Skill Proficiency.

Anticipatory motor planning abilities mature as children grow older, develop throughout childhood and are likely to be stable till the late sixties. In the seventh decade of life, motor planning performance dramatically declines, with anticipatory motor planning abilities falling to levels of those exhibited by children. At present, the processes enabling successful anticipatory motor planning in general, as do the cognitive processes mediating these age-related changes, remain elusive. Thus, the aim of the present study was (a) to identify cognitive and motor functions that are most affected by normal aging and (b) to elucidate key (cognitive and motor) factors that are critical for successful motor planning performance in young (n = 40, mean age = 23.1 ± 2.6 years) and older adults (n = 37, mean age = 73.5 ± 7.1 years). Results indicate that normal aging is associated with a marked decline in all aspects of cognitive and motor functioning tested. However, age-related declines were more apparent for fine motor dexterity, processing speed and cognitive flexibility. Furthermore, up to 64% of the variance in motor planning performance across age groups could be explained by the cognitive functions processing speed, response planning and cognitive flexibility. It can be postulated that anticipatory motor planning abilities are strongly influenced by cognitive control processes, which seem to be key mechanisms to compensate for age-related decline. These findings support the general therapeutic and preventive value of cognitive-motor training programs to reduce adverse effects associated with high age.

The effects of age and amplitude on wrist proprioceptive acuity.

This study examined wrist proprioception in a cross-sectional sample of 44 children aged between 8-to 14-years and a control group of 10 neurologically and physically healthy adults. Using a 3-degrees of freedom robotic device, participants performed an ipsilateral joint position matching task in which target amplitude (40% or 80% functional range of motion [fRoM]) and degrees-of-freedom (Flexion/Extension [FE], Radial/Ulnar deviation [RUD], Pronation/Supination [PS]) were manipulated. Results indicated that proprioceptive function became more accurate and consistent over the developmental spectrum, but that the ability to utilize proprioceptive feedback did not reach adult levels till the age of 10-11 years. Furthermore, proprioceptive acuity was influenced by target amplitude, such that movements were more accurate for the 80% fROM compared to the 40% fROM target for both the RUD and PS DoFs, independently of age. The present results provide critical information about the typical development of wrist proprioception that will enable clinicians to chart the course of development and dysfunction in neurological disorders in children, and help establish protocols for the robotic diagnosis and assessment of neurodevelopmental disorders.

The relation between measures of cognitive and motor functioning in 5- to 6-year-old children.

Specific relations between executive functions (working memory capacity, planning and problem-solving, inhibitory control) and motor skill performance (anticipatory motor planning, manual dexterity) were examined in 5- to 6-year-old children (N = 40). Results showed that the two motor skill components were not correlated. Additionally, it was found that response planning performance was a significant predictor of anticipatory motor planning performance, whereas inhibitory control and working memory capacity measures were significant predictors of manual dexterity scores. Taken together, these results suggest that cognitive and motor skills are linked, but that manual dexterity and anticipatory motor planning involve different specialized skills. The current study provides support for specific relations between cognitive and motor performance, which has implications for early childhood cognitive-motor training and intervention programs.

The influence of action possibility and end-state comfort on motor imagery of manual action sequences.

It has been proposed that the preparation of goal-direct actions involves internal movement simulation, or motor imagery. Evidence suggests that motor imagery is critically involved in the prediction of action consequences and contributes heavily to movement planning processes. The present study examined whether the sensitivity towards end-state comfort and the possibility/impossibility to perform an action sequence are considered during motor imagery. Participants performed a mental rotation task in which two images were simultaneously presented. The image on the left depicted the start posture of a right hand when grasping a bar, while the right image depicted the hand posture at the end of the action sequence. The right image displayed the bar in a vertical orientation with the hand in a comfortable (thumb-up) or in an uncomfortable (thumb-down) posture, while the bar in the left image was rotated in picture plane in steps of 45°. Crucially, the two images formed either a physically possible or physically impossible to perform action sequence. Results revealed strikingly different response time patterns for the two action sequence conditions. In general, response times increased almost monotonically with increasing angular disparity for the possible to perform action sequences. However, slight deviations from this monotonicity were apparent when the sequences contained an uncomfortable as opposed to a comfortable final posture. In contrast, for the impossible sequences, response times did not follow a typical mental rotation function, but instead were uniformly very slow. These findings suggest that both biomechanical constraints (i.e., end-state comfort) and the awareness of the possibility/impossibility to perform an action sequence are considered during motor imagery. We conclude that motor representations contain information about the spatiotemporal movement organization and the possibility of performing an action, which are crucially involved in anticipation and planning of action sequences.

Effects of multiple planning constraints on the development of grasp posture planning in 6- to 10-year-old children.

This experiment examined how multiple planning constraints affect grasp posture planning in 6- to 10-year-old children (n = 16 in each group) by manipulating the intended object end-orientation (left end-down, right end-down) and initial precision demands (standard, initial precision) of a bar transport task. Results indicated that grasp posture planning was strongly influenced by multiple planning constraints. During the standard condition the sensitivity toward comfortable final hand postures (end-state comfort) was similar for all age groups in right end-down trials, and corresponded to values reported in adult populations. In contrast, there was an age-related increase in end-state comfort compliance during left end-down trials. During the initial precision condition end-state comfort was similar across all groups for left end-down trials. However, end-state comfort compliance was significantly lower for the 6-year-old children than in all other age groups for right end-down trials. In sum, the ability of children to plan their goal-related movements is influenced by the presence of task-related constraints that increase the overall cognitive demands of the task. The demands associated with selecting the appropriate grasp posture during the most cognitive demanding condition required more cognitive resources than 6- to 10-year-old children possess. Removing the conflict between the goal-directed and habitual systems reduces some of these costs, with data indicating that the ability to integrate multiple planning constraints first emerges at 7 years of age, and improves over the developmental spectrum.

Frames of reference in action plan recall: influence of hand and handedness.

Evidence suggests that people are more likely to recall features of previous plans and use them for subsequent movements, rather than generating action plans from scratch for each movement. The information used for plan recall during object manipulation tasks is stored in extrinsic (object-centered) rather than intrinsic (body-centered) coordinates. The present study examined whether action plan recall processes are influenced by manual asymmetries. Right-handed (Experiment 1) and left-handed (Experiment 2) participants grasped a plunger from a home position using either the dominant or the non-dominant hand and placed it at one of the three target positions located at varying heights (home-to-target moves). Subsequently, they stepped sideways down from a podium (step-down podium), onto a podium (step-up podium), or without any podium present (no podium), before returning the plunger to the home platform using the same hand (target-back-to-home moves). The data show that, regardless of hand and handedness, participants grasped the plunger at similar heights during the home-to-target and target-back-to-home moves, even if they had to adopt quite different arm postures to do so. Thus, these findings indicate that the information used for plan recall processes in sequential object manipulation tasks is stored in extrinsic coordinates and in an effector-independent manner.

The influence of reducing intermediate target constraints on grasp posture planning during a three-segment object manipulation task.

The present experiment examined the influence of final target position on grasp posture planning during a three-segment object manipulation task in which the required object orientation at the first target position was unconstrained. Participants grasped a cylindrical object from a home position, placed it at an intermediate position in a freely chosen orientation, and subsequently placed it at one of four final target positions. Considerable inter-individual differences in initial grasp selection were observed which also led to differences in final grasp postures. Whereas some participants strongly adjusted their initial grasp postures to the final target orientation, and thus showed a preference for end-state comfort, other participants showed virtually no adjustment in initial grasp postures, hence satisfying initial-state comfort. Interestingly, as intermediate grasp postures were similar regardless of initial grasp adjustment, intermediate-state comfort was prioritized by all participants. These results provide further evidence for the interaction of multiple action selection constraints in grasp posture planning during multi-segment object manipulation tasks. Whereas some constraints may take strict precedence in a given task, other constraints may be more flexible and weighted differently among participants. This differentiated weighting leads to task- and subject-specific constraint hierarchies and is reflected in inter-individual differences in grasp selection.

The application of SHERPA (Systematic Human Error Reduction and Prediction Approach) in the development of compensatory cognitive rehabilitation strategies for stroke patients with left and right brain damage.

Approximately 33% of stroke patients have difficulty performing activities of daily living, often committing errors during the planning and execution of such activities. The objective of this study was to evaluate the ability of the human error identification (HEI) technique SHERPA (Systematic Human Error Reduction and Prediction Approach) to predict errors during the performance of daily activities in stroke patients with left and right hemisphere lesions. Using SHERPA we successfully predicted 36 of the 38 observed errors, with analysis indicating that the proportion of predicted and observed errors was similar for all sub-tasks and severity levels. HEI results were used to develop compensatory cognitive strategies that clinicians could employ to reduce or prevent errors from occurring. This study provides evidence for the reliability and validity of SHERPA in the design of cognitive rehabilitation strategies in stroke populations.

H-Man: a planar, H-shape cabled differential robotic manipulandum for experiments on human motor control.

In the last decades more robotic manipulanda have been employed to investigate the effect of haptic environments on motor learning and rehabilitation. However, implementing complex haptic renderings can be challenging from technological and control perspectives. We propose a novel robot (H-Man) characterized by a mechanical design based on cabled differential transmission providing advantages over current robotic technology. The H-Man transmission translates to extremely simplified kinematics and homogenous dynamic properties, offering the possibility to generate haptic channels by passively blocking the mechanics, and eliminating stability concerns. We report results of experiments characterizing the performance of the device (haptic bandwidth, Z-width, and perceived impedance). We also present the results of a study investigating the influence of haptic channel compliance on motor learning in healthy individuals, which highlights the effects of channel compliance in enhancing proprioceptive information. The generation of haptic channels to study motor redundancy is not easy for actual robots because of the needs of powerful actuation and complex real-time control implementation. The mechanical design of H-Man affords the possibility to promptly create haptic channels by mechanical stoppers (on one of the motors) without compromising the superior backdriveability and high isotropic manipulability. This paper presents a novel robotic device for motor control studies and robotic rehabilitation. The hardware was designed with specific emphasis on the mechanics that result in a system that is easy to control, homogeneous, and is intrinsically safe for use.

The tool in the brain: apraxia in ADL. Behavioral and neurological correlates of apraxia in daily living.

Humans differ from other animals in the way they can skilfully and precisely operate or invent tools to facilitate their everyday life. Tools have dominated our home, travel and work environment, becoming an integral step for our motor skills development. What happens when the part of the brain responsible for tool use is damaged in our adult life due to a cerebrovascular accident? How does daily life change when we lose the previously mastered ability to make use of the objects around us? How do patients suffering from compromised tool use cope with food preparation, personal hygiene, grooming, housework, or use of home appliances? In this literature review we present a state of the art for single and multiple tool use research, with a focus on the impact that apraxia (impaired ability to perform tool-based actions) and action disorganization syndrome (ADS; impaired ability to carry out multi-step actions) have on activities of daily living (ADL). Firstly, we summarize the behavioral studies investigating the impact of apraxia and other comorbidity syndromes, such as neglect or visual extinction, on ADL. We discuss the hallmarks of the compromised tool use in terms of the sequencing of action steps, conceptual errors committed, spatial motor control, and temporal organization of the movement. In addition, we present an up-to-date overview of the neuroimaging and lesion analyses studies that provide an insight into neural correlates of tool use in the human brain and functional changes in the neural organization following a stroke, in the context of ADL. Finally we discuss the current practice in neurorehabilitation of ADL in apraxia and ADS aiming at increasing patients' independence.