Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial.

This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.

Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy.

BACKGROUND: Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity. OBJECTIVE: To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP. METHODS: There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated. RESULTS: Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040). CONCLUSIONS: Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects. CLINICALTRIALS.GOV REGISTRY: NCT02584491 and NCT02754128.

The role of oral and pharyngeal motor exercises in post-stroke recovery: A scoping review.

OBJECTIVE: To analyze intervention goals, protocols, and outcome measures used for oral and pharyngeal motor exercises in post-stroke recovery. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane databases were searched in September 2022. METHODS: Studies were included if they (1) recruited post-stroke adult patients, (2) administered exercises for the oral and/ or pharyngeal muscles, and (3) reported results at baseline and post-exercise. The extracted data included intervention goals, protocols, and outcomes. All outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). RESULTS: A total of 26 studies were identified. Their intervention goals aimed to rehabilitate a broad spectrum of muscle groups within the oral cavity and pharynx and to improve the functions of swallowing, speech, facial expressions, or sleep breathing. Protocol duration ranged from 1 to 13 weeks, with various exercise repetitions (times per day) and frequency (days per week). Half of the studies reported using feedback to support the training, and these studies varied in the feedback strategy and technology tool. A total of 37 unique outcome measures were identified. Most measures represented the body functions and body structure component of the ICF, and several of these measures showed large treatment effects. CONCLUSIONS: This review demonstrated inconsistency across published studies in intervention goals and exercise protocols. It has also identified current limitations and provided recommendations for the selection of outcome measures while advancing a multidisciplinary view of oral and pharyngeal exercises in post-stroke recovery across relevant functions.

Psychometric Properties of a New Measure of Upper Limb Performance in Post-Stroke Individuals: Trunk-Based Index of Performance.

BACKGROUND: Several measures of upper limb (UL) motor tasks have been developed to characterize recovery. However, UL performance and movement quality measures in isolation may not provide a true profile of functional recovery. OBJECTIVE: To investigate the measurement properties of a new trunk-based Index of Performance (IPt) of the UL combining endpoint performance (accuracy and speed) and movement quality (trunk displacement) in stroke. METHODS: Participants with stroke (n = 25, mean time since stroke: 18.7 ± 17.2 months) performed a reaching task over 3 evaluation sessions. The IPt was computed based on Fitts' Law that incorporated endpoint accuracy and speed corrected by the amount of trunk displacement. Test-retest reliability was analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. Standard error of measurement (SEM) and Minimal Detectable Change (MDC) were determined. Validity was investigated through the relationship between IPt, Fugl-Meyer Assessment (FMA-UE), and Action Research Arm Test (ARAT), as well as the ability of IPt to distinguish between levels of UL motor impairment severity. RESULTS: Test-retest reliability was excellent (ICC = .908, 95% CI: 0.807-0.96). Bland-Altman did not show systematic differences. SEM and MDC95 were 14% and 39%, respectively. Construct validity was satisfactory. The IPt showed low-to-moderate relationships with FMA-UE (R2 ranged from .236 to .428) and ARAT (R2 ranged from .277 to .306). IPt scores distinguished between different levels of UL severity. CONCLUSIONS: The IPt showed evidence of good reliability, and initial validity. The IPt may be a promising tool for research and clinical settings. Further research is warranted to investigate its validity with additional comparator instruments.

Transcranial direct current stimulation leads to faster acquisition of motor skills, but effects are not maintained at retention.

Practice is required to improve one's shooting technique in basketball or to play a musical instrument well. Learning these motor skills may be further enhanced by transcranial direct current stimulation (tDCS). We aimed to investigate whether tDCS leads to faster attainment of a motor skill, and to confirm prior work showing it improves skill acquisition and retention performance. Fifty-two participants were tested; half received tDCS with the anode on primary motor cortex and cathode on the contralateral forehead while concurrently practicing a sequential visuomotor isometric pinch force task on Day 1, while the other half received sham tDCS during practice. On Day 2, retention of the skill was tested. Results from a Kaplan-Meier survival analysis showed that participants in the anodal group attained a pre-defined target level of skill faster than participants in the sham group (χ2 = 9.117, p = 0.003). Results from a nonparametric rank-based regression analysis showed that the rate of improvement was greater in the anodal versus sham group during skill acquisition (F(1,249) = 5.90, p = 0.016), but there was no main effect of group or time. There was no main effect of group or time, or group by time interaction when comparing performance at the end of acquisition to retention. These findings suggest anodal tDCS improves performance more quickly during skill acquisition but does not have additional benefits on motor learning after a period of rest.

Atypical Functional Connectivity During Unfamiliar Music Listening in Children With Autism.

Background: Atypical processing of unfamiliar, but less so familiar, stimuli has been described in Autism Spectrum Disorder (ASD), in particular in relation to face processing. We examined the construct of familiarity in ASD using familiar and unfamiliar songs, to investigate the link between familiarity and autism symptoms, such as repetitive behavior. Methods: Forty-eight children, 24 with ASD (21 males, mean age = 9.96 years ± 1.54) and 24 typically developing (TD) controls (21 males, mean age = 10.17 ± 1.90) completed a music familiarity task using individually identified familiar compared to unfamiliar songs, while magnetoencephalography (MEG) was recorded. Each song was presented for 30 s. We used both amplitude envelope correlation (AEC) and the weighted phase lag index (wPLI) to assess functional connectivity between specific regions of interest (ROI) and non-ROI parcels, as well as at the whole brain level, to understand what is preserved and what is impaired in familiar music listening in this population. Results: Increased wPLI synchronization for familiar vs. unfamiliar music was found for typically developing children in the gamma frequency. There were no significant differences within the ASD group for this comparison. During the processing of unfamiliar music, we demonstrated left lateralized increased theta and beta band connectivity in children with ASD compared to controls. An interaction effect found greater alpha band connectivity in the TD group compared to ASD to unfamiliar music only, anchored in the left insula. Conclusion: Our results revealed atypical processing of unfamiliar songs in children with ASD, consistent with previous studies in other modalities reporting that processing novelty is a challenge for ASD. Relatively typical processing of familiar stimuli may represent a strength and may be of interest to strength-based intervention planning.

Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial.

BACKGROUND & OBJECTIVE: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5-45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. METHODS: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. RESULTS: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/P = .015). There was no significant rTMS effect in the chronic aphasia group. CONCLUSIONS: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02020421.

The Effect of Rhythm Abilities on Metronome-Cued Walking with an Induced Temporal Gait Asymmetry in Neurotypical Adults.

ABSRACT. Human gait is inherently rhythmical, thus walking to rhythmic auditory stimulation is a promising intervention to improve temporal gait asymmetry (TGA) following neurologic injury such as stroke. However, the degree of benefit may relate to an individual's underlying rhythmic ability. We conducted an initial investigation into the relationship between rhythm abilities and responsiveness of TGA when walking to a metronome. TGA was induced in neurotypical young adults with ankle and thigh cuff weights. Participants were grouped by strong or weak rhythm ability based on beat perception and production tests. TGA was induced using a unilateral load affixed to the non-dominant leg. Participants walked under three conditions: uncued baseline, metronome set to 100% of baseline cadence, and metronome set to 90% of baseline cadence. Repeated measures analysis using generalized estimating equations was conducted to determine how rhythm ability affected TGA response in each walking condition. Most participants improved TGA when walking to a metronome at either tempo compared to baseline; however, this improvement did not differ between strong and weak rhythm ability groups. Those who scored worse on the rhythm perception test also were poorer at synchronizing their steps to the beat. The induced TGA is smaller than what is commonly experienced after stroke. A larger induced TGA may be necessary to reveal subtle differences in responsiveness to rhythmical auditory stimulation between those with strong and weak rhythm abilities.

Comparison of sports skills movement training to lower limb strength training for independently ambulatory children with cerebral palsy: a randomised feasibility trial.

PURPOSE: The best approach to delivering advanced gross motor skills interventions for children with cerebral palsy (CP) is unknown. This study's aim was to assess trial feasibility and compare effectiveness of sports skills movement training (Brain change after Fun, Athletic Sports skills Training [BeFAST]) to conventional lower limb strength training (Brain change after Strength Training focusing ON Gait [BeSTRONG]) for improving advanced gross motor skills of children with CP. METHODS: Twenty independently ambulatory children with CP (mean age 12 ± 2.6 years) were randomly assigned to a 6-week programme of BeFAST or BeSTRONG, individualised to participant goals. Primary scientific outcome measures were the Challenge and Canadian Occupational Performance Measure (COPM) assessed pre/post and 4-month post-intervention. Process, resource, and management indicators assessed trial feasibility. RESULTS: There was no between group difference for the Challenge (p = 0.325), however significant post-intervention Challenge improvements were observed in BeFAST (p = 0.031) but not BeSTRONG (p = 0.055). Between group post-intervention scores were higher in BeFAST for COPM Performance (p = 0.001), and relative gains were maintained 4-month post-intervention. Pre-set criteria were met for 84% of feasibility indicators. CONCLUSIONS: Sports skills movement training may be an effective option to support advanced gross motor skill gains and target goals of independently ambulatory children with CP. Trial feasibility, including early evidence of effectiveness, indicates readiness for a full-scale randomised trial.Implications for rehabilitationChildren with cerebral palsy have potential to improve advanced gross motor skills.Strength training is a commonly used approach in gross motor therapy programmes.Sports skill training may be an effective option that better targets children's goals.

Response patterns to vowel formant perturbations in children.

Auditory feedback is an important component of speech motor control, but its precise role in developing speech is less understood. The role of auditory feedback in development was probed by perturbing the speech of children 4-9 years old. The vowel sound /ɛ/ was shifted to /æ/ in real time and presented to participants as their own auditory feedback. Analyses of the resultant formant magnitude changes in the participants' speech indicated that children compensated and adapted by adjusting their formants to oppose the perturbation. Older and younger children responded to perturbation differently in F1 and F2. The compensatory change in F1 was greater for younger children, whereas the increase in F2 was greater for older children. Adaptation aftereffects were observed in both groups. Exploratory directional analyses in the two-dimensional formant space indicated that older children responded more directly and less variably to the perturbation than younger children, shifting their vowels back toward the vowel sound /ɛ/ to oppose the perturbation. Findings support the hypothesis that auditory feedback integration continues to develop between the ages of 4 and 9 years old such that the differences in the adaptive and compensatory responses arise between younger and older children despite receiving the same auditory feedback perturbation.

The prevalence of the Val66Met polymorphism in musicians: Possible evidence for compensatory neuroplasticity from a pilot study.

The study compared the prevalence of the Val66Met Brain-derived Neurotrophic Factor single nucleotide polymorphism (rs6265) in a sample of musicians (N = 50) to an ethnically matched general population sample from the 1000 Human Genome Project (N = 424). Met-carriers of the polymorphism (Val/Met and Met/Met genotypes) are typically present in 25-30% of the general population and have associated deficits in motor learning and plasticity. Many studies have assessed the benefits of long-term music training for neuroplasticity and motor learning. This study takes a unique genetic approach investigating if the prevalence of the Val66Met BDNF polymorphism, which negatively affects motor learning, is significantly different in musicians from the general population. Our genotype and allele frequency analyses revealed that the distribution of the Val66Met polymorphism was not significantly different in musicians versus the general population (p = 0.6447 for genotype analysis and p = 0.8513 allele analysis). In the Musician sample (N = 50), the prevalence of the Val/Met genotype was 40% and the prevalence of the Met/Met genotype was 2%. In the 1000 Human Genome Project subset (N = 424), the prevalence of Val/Met was 33.25% and the Met/Met genotype prevalence was 4%. Therefore, musicians do exist with the Val66Met polymorphism and the characteristics of long-term music training may compensate for genetic predisposition to motor learning deficits. Since the polymorphism has significant implications for stroke rehabilitation, future studies may consider the implications of the polymorphism in music-based interventions such as Neurologic Music Therapy.

Does Cathodal vs. Sham Transcranial Direct Current Stimulation Over Contralesional Motor Cortex Enhance Upper Limb Motor Recovery Post-stroke? A Systematic Review and Meta-analysis.

Background: During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery. Objective: The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS. Methods: We searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for participants with stroke (>1 week post-onset) with motor impairment and who received cathodal or sham tDCS to contralesional M1 for one or more sessions. The outcomes included a change in any clinically validated assessment of physical function, activity, or participation, or a change in a movement performance variable (e.g., time, accuracy). A meta-analysis was performed by pooling five randomized controlled trials (RCTs) and comparing the change in Fugl-Meyer upper extremity scores between cathodal and sham tDCS groups. Results: Eleven studies met the inclusion criteria. Qualitatively, four out of five cross-over design studies and three out of six RCTs reported a significant effect of cathodal vs. sham tDCS. In the quantitative synthesis, cathodal tDCS (n = 65) did not significantly reduce motor impairment compared to sham tDCS (n = 67; standardized mean difference = 0.33, z = 1.79, p = 0.07) with a little observed heterogeneity (I 2 = 5%). Conclusions: The effects of cathodal tDCS to contralesional M1 on motor recovery are small and consistent. There may be sub-populations that may respond to this approach; however, further research with larger cohorts is required.

Perceptions of an over-ground induced temporal gait asymmetry by healthy young adults.

Nearly 60% of individuals with stroke walk with temporal gait asymmetry (TGA; a phase inequality between the legs during gait). About half of individuals with TGA are unable to correctly identify the presence or direction of their asymmetry. If patients are unable to perceive their gait errors, it will be harder to correct them to improve their gait pattern. Perception of gait pattern error may be affected by the stroke itself; therefore, the objectives of this study were to determine how the gait of neurotypical individuals changes with an induced temporal asymmetry, and how perception of that TGA compares to actual asymmetry both before and after 15-min of exposure to the induced asymmetry. After baseline symmetry (measured as symmetry index (SI)) was assessed with a pressure sensitive mat, participants (n = 29) walked for 15 min over-ground with cuff weights (7.5% of body weight) on their non-dominant leg to induce TGA. Presence, direction, and magnitude of TGA was measured at five time points: 1) baseline, 2) immediately after unilateral loading (early adaptation (EA)), 3) at the end of 15 min of walking (late adaptation (LA)), 4) immediately after load removal (early deadaptation (EDA)), and 5) after the participant indicated that their gait had returned to baseline symmetry (late deadaptation (LDA). Presence, direction, and magnitude of perceived TGA was measured by self-report. Measured and perceived TGA changes over time were assessed with separate one-way repeated measures analyses of variance. Agreement between measured and perceived TGA was assessed. During EA, all participants walked asymmetrically, spending more time on the non-loaded limb compared to baseline (-12.67 [95%CI -14.56, -10.78], p < 0.0001). All but one participant perceived this TGA, however only fifteen (52%) correctly perceived both TGA presence and direction. At LA, the group remained asymmetric (-9.22 [95%CI -11.32, -7.12], p < 0.0001), but only 9 participants (31%) correctly perceived both the presence and direction of their TGA. Visual inspection of the data at each time point revealed most participants perceived TGA magnitude as greater than actual TGA. Overall, we find that TGA can be induced and maintained in neurotypical young adults. Perception of TGA direction is inaccurate and perception of TGA magnitude is grossly overestimated. Perceptions of TGA do not improve after a period of exposure to the new walking pattern. These preliminary findings indicate that accurately perceiving an altered gait pattern is a difficult task even for healthy young adults.

Effects of therapeutic instrumental music performance and motor imagery on chronic post-stroke cognition and affect: A randomized controlled trial.

BACKGROUND: The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders. OBJECTIVE: To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals. METHODS: Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session. RESULTS: Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained. CONCLUSIONS: The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.

Aerobic exercise and aerobic fitness level do not modify motor learning.

Motor learning may be enhanced when a single session of aerobic exercise is performed immediately before or after motor skill practice. Most research to date has focused on aerobically trained (AT) individuals, but it is unknown if aerobically untrained (AU) individuals would equally benefit. We aimed to: (a) replicate previous studies and determine the effect of rest (REST) versus exercise (EXE) on motor skill retention, and (b) explore the effect of aerobic fitness level (AU, AT), assessed by peak oxygen uptake (VO2peak), on motor skill retention after exercise. Forty-four participants (20-29 years) practiced a visuomotor tracking task (acquisition), immediately followed by 25-min of high-intensity cycling or rest. Twenty-four hours after acquisition, participants completed a motor skill retention test. REST and EXE groups significantly improved motor skill performance during acquisition [F(3.17, 133.22) = 269.13, P = 0.001], but had no group differences in motor skill retention across time. AU-exercise (VO2peak = 31.6 ± 4.2 ml kg-1 min-1) and AT-exercise (VO2peak = 51.5 ± 7.6 ml kg-1 min-1) groups significantly improved motor skill performance during acquisition [F(3.07, 61.44) = 155.95, P = 0.001], but had no group differences in motor skill retention across time. Therefore, exercise or aerobic fitness level did not modify motor skill retention.

Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study.

OBJECTIVE: To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis. DESIGN: Randomized-controlled pilot study. SETTING: University research facility. PARTICIPANTS: Community-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months). INTERVENTION: Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment. MAIN OUTCOME MEASURES: Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)-amount of use scale and trunk impairment scale. RESULTS: All groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63). CONCLUSION: TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

HIIT the Road Jack: An Exploratory Study on the Effects of an Acute Bout of Cardiovascular High-Intensity Interval Training on Piano Learning.

Pairing high-intensity interval training (HIIT) with motor skill acquisition may improve learning of some implicit motor sequences (albeit with some variability), but it is unclear if HIIT enhances explicit learning of motor sequences. We asked whether a single bout of HIIT after non-musicians learned to play a piano melody promoted better retention of the melody than low-intensity interval training (LIIT). Further, we investigated whether HIIT facilitated transfer of learning to a new melody. We generated individualized exercise protocols by having participants (n = 25) with little musical training undergo a graded maximal exercise test (GXT) to determine their cardiorespiratory fitness (VO2 peak) and maximum power output (Wmax). In a subsequent session, participants practiced a piano melody (skill acquisition) and were randomly assigned to a single bout of HIIT or LIIT. Retention of the piano melody was tested 1 hour, 1 day, and 1 week after skill acquisition. We also evaluated transfer to learning a new melody 1 week after acquisition. Pitch and rhythm accuracy were analyzed with linear mixed-effects modeling. HIIT did not enhance sequence-specific retention of pitch or rhythmic elements of the piano melody, but there was modest evidence that HIIT facilitated transfer to learning a new melody. We tentatively conclude that HIIT enhances explicit, task-general motor consolidation.

An Initial Investigation of the Responsiveness of Temporal Gait Asymmetry to Rhythmic Auditory Stimulation and the Relationship to Rhythm Ability Following Stroke.

Temporal gait asymmetry (TGA) is a persistent post-stroke gait deficit. Compared to conventional gait training techniques, rhythmic auditory stimulation (RAS; i.e., walking to a metronome) has demonstrated positive effects on post-stroke TGA. Responsiveness of TGA to RAS may be related to several factors including motor impairment, time post-stroke, and individual rhythm abilities. The purpose of this study was to investigate the relationship between rhythm abilities and responsiveness of TGA when walking to RAS. Assessed using behavioral tests of beat perception and production, participants with post-stroke TGA (measured as single limb support time ratio) were categorized according to rhythm ability (as strong or weak beat perceivers/producers). We assessed change in TGA between walking without cues (baseline) and walking while synchronizing footsteps with metronome cues. Most individuals with stroke were able to maintain or improve TGA with a single session of RAS. Within-group analyses revealed a difference between strong and weak rhythm ability groups. Strong beat perceivers and producers showed significant reduction (improvement) in TGA with the metronome. Those with weak ability did not and exhibited high variability in the TGA response to metronome. Moreover, individuals who worsened in TGA when walking to metronome had poorer beat production scores than those who did not change in TGA. However, no interaction between TGA improvement when walking to metronome and rhythm perception or production ability was found. While responsiveness of TGA to RAS did not significantly differ based on strength of rhythm abilities, these preliminary findings highlight rhythm ability as a potential consideration when treating post-stroke individuals with rhythm-based treatments.

Determining Corticospinal Tract Injury from Stroke Using Computed Tomography.

INTRODUCTION: Damage to the corticospinal tract (CST) from stroke leads to motor deficits. The damage can be quantified as the amount of overlap between the stroke lesion and CST (CST Injury). Previous literature has shown that the degree of motor deficits post-stroke is related to the amount of CST Injury. These studies delineate the stroke lesion from structural T1-weighted magnetic resonance imaging (MRI) scans, often acquired for research. In Canada, computed tomography (CT) is the most common imaging modality used in routine acute stroke care. In this proof-of-principle study, we determine whether CST Injury, using lesions delineated from CT scans, significantly explains the variability in motor impairment in individuals with stroke. METHODS: Thirty-seven participants with stroke were included in this study. These individuals had a CT scan within the acute stage (7 days) of their stroke and underwent motor assessments. Brain images from CT scans were registered to MRI space. We performed a stepwise regression analysis to determine the contribution of CST injury and demographic variables in explaining motor impairment variability. RESULTS: Using clinically available CT scans, we found modest evidence that CST Injury explains variability in motor impairment (R2adj = 0.12, p = 0.02). None of the participant demographic variables entered the model. CONCLUSION: We show for the first time a relationship between CST Injury and motor impairment using CT scans. Further work is required to evaluate the utility of data derived from clinical CT scans as a biomarker of stroke motor recovery.