Major Depression and the Perception of Affective Instrumental and Expressive Gestures: An fMRI Investigation.

Major depressive disorder (MDD) is associated with biased perception of human movement. Gesture is important for communication and in this study we investigated neural correlates of gesture perception in MDD. We hypothesised different neural activity between individuals with MDD and typical individuals when viewing instrumental and expressive gestures that were negatively or positively valenced. Differences were expected in brain areas associated with gesture perception, including superior temporal, frontal, and emotion processing regions. We recruited 12 individuals with MDD and 12 typical controls matched on age, gender, and handedness. They viewed gestures displayed by stick figures while functional magnetic resonance imaging (fMRI) was performed. Results of a random effects three-way mixed ANOVA indicated that individuals with MDD had greater activity in the right claustrum compared to controls, regardless of gesture type or valence. Additionally, we observed main effects of gesture type and valence, regardless of group. Perceiving instrumental compared to expressive gestures was associated with greater activity in the left cuneus and left superior temporal gyrus, while perceiving negative compared to positive gestures was associated with greater activity in the right precuneus and right lingual gyrus. We also observed a two-way interaction between gesture type and valence in various brain regions.

An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study.

BACKGROUND: Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. OBJECTIVE: This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. METHODS: This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. RESULTS: In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. CONCLUSIONS: This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi.org/10.3389/fresc.2021.820929.

The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke.

BACKGROUND: Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. METHODS: We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR 'taster' sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. RESULTS: Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). CONCLUSIONS: HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder.

A Mapping Review of Real-Time Movement Sonification Systems for Movement Rehabilitation.

Movement sonification is emerging as a useful tool for rehabilitation, with increasing evidence in support of its use. To create such a system requires component considerations outside of typical sonification design choices, such as the dimension of movement to sonify, section of anatomy to track, and methodology of motion capture. This review takes this emerging and highly diverse area of literature and keyword-code existing real-time movement sonification systems, to analyze and highlight current trends in these design choices, as such providing an overview of existing systems. A combination of snowballing through relevant existing reviews and a systematic search of multiple databases were utilized to obtain a list of projects for data extraction. The review categorizes systems into three sections: identifying the link between physical dimension to auditory dimension used in sonification, identifying the target anatomy tracked, identifying the movement tracking system used to monitor the target anatomy. The review proceeds to analyze the systematic mapping of the literature and provide results of the data analysis highlighting common and innovative design choices used, irrespective of application, before discussing the findings in the context of movement rehabilitation. A database containing the mapped keywords assigned to each project are submitted with this review.

Sharing positive behavior change made during COVID-19 lockdown: A mixed-methods coproduction study.

OBJECTIVE: The negative consequences of coronavirus disease 2019 (COVID-19) national lockdowns have been well documented, including the worsening of mental health for many and the amplification of preexisting inequalities. As a counterpoint, the current study uses a mixed-methods coproduction approach to share psychosocial insights into the adoption of positive changes made during national lockdown in Scotland. This study examines the psychosocial patterning of positive behavior changes and the psychosocial processes by which positive change was realized and shared these insights with partner organizations. METHOD: A sequential mixed-methods design included an online survey (N = 2,445) assessing positive changes in sleep and physical activity patterns and the role of sociodemographics, mood, social support, coping, and resilience using multivariate logistic regression analysis. Interviews were performed with a purposive diverse subsample of people self-reporting high levels of positive change (n = 48) and used thematic analysis. RESULTS: The survey identified that positive behavior change was significantly patterned by age, gender, and vulnerability to COVID-19. Higher levels of positive reframing and active coping in relation to stress were associated with higher levels of positive behavior change. Higher symptoms of depression, planning, and self-distraction were associated with less positive behavior change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine, and purposefully build self-efficacy and a sense of control were key to initiating positive change. CONCLUSIONS: The current study yields insights into achieving positive behavior change at a time of international crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What have we learned about positive changes experienced during COVID-19 lockdown? Evidence of the social patterning of change.

BACKGROUND: Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. METHODS: The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. RESULTS: There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. CONCLUSION: Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.

A Co-creation Centre for Accessible Rehabilitation Technology.

Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry. Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021-31/12/2021) investigating acceptability and feasibility, due to report findings in 2022. Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.

Changes in Physical Activity, Sitting and Sleep across the COVID-19 National Lockdown Period in Scotland.

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.

Community cycling exercise for stroke survivors is feasible and acceptable.

Background: Physical activity is recommended after stroke but levels for stroke survivors are typically low. The use of indoor recumbent cycling, delivered through local government leisure facilities, may increase access to exercise among stroke survivors. Objective: This study aimed to evaluate the acceptability and feasibility of an indoor cycling program delivered through existing local government services. Methods: Participants were recruited through stroke liaison nurses and public advertising. After a home visit to assess eligibility and conduct psychological and general health assessments, participants attended their local leisure center for an initial fitness test and short battery of physical tests. Then, an 8 week training program was designed with weekly goals. Following the program the assessments were retaken along with an evaluation questionnaire. In-depth, semi-structured, interviews were conducted with 15 participants and five fitness coaches. Results: One hundred fifteen individuals volunteered to participate during a 10-month recruitment period, 77 met the inclusion criteria and consented, 66/77 (86%) completed the program including all nine non-ambulatory participants. The program and procedures (recruitment and outcome measures) were feasible and acceptable to participants (81% reported following the program). Participants were generally very positive about the experience. Significant improvements in sit-to-stand capacity (Mpre = 25.2 s, Mpost = 19.0 s, p = .002), activities of daily living (NEADL, Mpre = 12.2, Mpost = 13.2, p = .002), psychosocial functioning (SAQOL, Mpre = 3.82, Mpost = 4.15, p = .001), energy (SAQOL, Mpre = 3.75, Mpost = 4.02, p = .018) and depression (GHQ, Mpre = .97, Mpost = .55, p = .009) were observed. Conclusion: A cycling-based exercise program delivered through local leisure center staff and facilities was shown to be feasible and acceptable for people living with stroke.

The Effect of False Positive Feedback on Learning an Inhibitory-Action Task in Older Adults.

Background/Study Context: Older adults show a greater response to feedback whilst learning than younger adults. To date this has only been shown for receiving veridical feedback, but there is evidence that suggests that receiving false positive feedback may further enhance learning. We tested the hypothesis that receiving false positive feedback, being told you are preforming better than expected, would be more advantageous for older than younger adults when learning an inhibitory-action task. Methods: 42 younger and 34 older adults trained to improve their inhibition and response times on the Simon task. They completed 18 training blocks and a retention test two weeks after training. Participants received either false positive feedback or veridical feedback on their performance at the end of each training session and the start of the next session. Those in the false positive feedback group were told they were performing faster than expected. Results: Both older and younger adults improved their inhibition and response times but receiving false positive feedback did not significantly change their rate of learning on these outcomes. However, false positive feedback did impact on accuracy levels with those receiving this type of feedback making fewer errors. Older adults were slower but more accurate than younger adults, but contrary to our hypothesis they did not benefit more from false positive feedback than younger adults. Conclusion: This first direct comparison of the effects of false positive feedback on older and younger adults showed that the positive impact of false positive feedback does not decline with age. We also demonstrated that feedback given about one aspect of a skill (in this case speed) may in fact influence another aspect of the skill (in this case accuracy). This suggests that false positive feedback could be used as a motivational tool to enhance cognitive-motor learning in older adults, but care needs to be taken when using this, as the feedback may not affect the element of the skill at which it is targeted.

Aging and the prevalence of 'ironic' action errors under avoidant instruction.

Action errors can put older adults at risk of injury. Our study is the first to investigate whether older adults are more prone than younger adults to making 'ironic' motor errors (i.e., actions they have been instructed not to perform), or over-compensatory motor errors (e.g., moving more to the right when instructed not to move to the left). We also investigated whether error patterns change under cognitive load, and assessed whether age effects in the ability to inhibit a prohibited action are comparable to the age decrements found in the ability to inhibit a natural perception-action coupling in the Simon task. Sixty-four older (Mean = 70.64 years, SD = 5.81) and 39 younger (Mean = 28.74 years, SD = 16.39) adults completed an avoidant instruction line-drawing task (with and without cognitive load), and the Simon task. Older adults showed significantly slower inhibition times than younger adults on the Simon task, as expected, and in line with previous research. Surprisingly, however, older adults outperformed younger adults on the avoidant instruction task, producing fewer ironic and over-compensatory errors, and they performed similarly to the younger adults under cognitive load. Age-related decrements on the Simon but not the avoidant instruction task suggests that the two different types of motor tasks involve different subtypes of inhibition which likely recruit independent cognitive processes and neural circuitry in older age. It is speculated that the older adults' superior ability to inhibit a prohibited action could be the result of age-related changes in distractibility.

Socio-cognitive load and social anxiety in an emotional anti-saccade task.

The anti-saccade task has been used to measure attentional control related to general anxiety but less so with social anxiety specifically. Previous research has not been conclusive in suggesting that social anxiety may lead to difficulties in inhibiting faces. It is possible that static face paradigms do not convey a sufficient social threat to elicit an inhibitory response in socially anxious individuals. The aim of the current study was twofold. We investigated the effect of social anxiety on performance in an anti-saccade task with neutral or emotional faces preceded either by a social stressor (Experiment 1), or valenced sentence primes designed to increase the social salience of the task (Experiment 2). Our results indicated that latencies were significantly longer for happy than angry faces. Additionally, and surprisingly, high anxious participants made more erroneous anti-saccades to neutral than angry and happy faces, whilst the low anxious groups exhibited a trend in the opposite direction. Results are consistent with a general approach-avoidance response for positive and threatening social information. However increased socio-cognitive load may alter attentional control with high anxious individuals avoiding emotional faces, but finding it more difficult to inhibit ambiguous faces. The effects of social sentence primes on attention appear to be subtle but suggest that the anti-saccade task will only elicit socially relevant responses where the paradigm is more ecologically valid.

Functional neuroimaging of visual creativity: a systematic review and meta-analysis.

INTRODUCTION: The generation of creative visual imagery contributes to technological and scientific innovation and production of visual art. The underlying cognitive and neural processes are, however, poorly understood. METHODS: This review synthesizes functional neuroimaging studies of visual creativity. Seven functional magnetic resonance imaging (fMRI) and 19 electroencephalography (EEG) studies were included, comprising 27 experiments and around 800 participants. RESULTS: Activation likelihood estimation meta-analysis of the fMRI studies comparing visual creativity to non-rest control tasks yielded significant clusters in thalamus, left fusiform gyrus, and right middle and inferior frontal gyri. The EEG studies revealed a tendency for decreased alpha power during visual creativity compared to baseline, but comparisons of visual creativity to non-rest control tasks revealed inconsistent findings. CONCLUSIONS: The findings are consistent with suggested contributions to visual creativity of prefrontally mediated inhibition, evaluation, and working memory, as well as visual imagery processes. Findings are discussed in relation to prominent theories of the neural basis of creativity.

The Effects of Increased Body Temperature on Motor Control during Golf Putting.

This study investigated the effect of increased core temperature on the performance outcome and movement kinematics of elite golfers during a golf putting task. The study aimed to examine individual differences in the extent to which increased temperature influenced the rate of putting success, whether increased temperature speeded up the timing of the putting downswing and whether elite golfers changed their movement kinematics during times of thermal stress. Six participants performed 20 putts to each of four putt distances (1, 2, 3, and 4 m) under normal temperature conditions and when core body temperature was increased. There was no significant difference in the number of successful putts between the two temperature conditions, but there was an increase in putterhead velocity at ball impact on successful putts to distances of 1 and 4 m when temperature was elevated. This reflected an increase in swing amplitude rather than a reduction in swing duration as hypothesized. There were individual differences in the motor control response to thermal stress as three of the golfers changed the kinematic parameters used to scale their putting movements to achieve putts of different distances at elevated temperatures. Theoretical implications for these findings and the practical implications for elite golfers and future research are discussed.

The Effect of Self-Referential Expectation on Emotional Face Processing.

The role of self-relevance has been somewhat neglected in static face processing paradigms but may be important in understanding how emotional faces impact on attention, cognition and affect. The aim of the current study was to investigate the effect of self-relevant primes on processing emotional composite faces. Sentence primes created an expectation of the emotion of the face before sad, happy, neutral or composite face photos were viewed. Eye movements were recorded and subsequent responses measured the cognitive and affective impact of the emotion expressed. Results indicated that primes did not guide attention, but impacted on judgments of valence intensity and self-esteem ratings. Negative self-relevant primes led to the most negative self-esteem ratings, although the effect of the prime was qualified by salient facial features. Self-relevant expectations about the emotion of a face and subsequent attention to a face that is congruent with these expectations strengthened the affective impact of viewing the face.

Perceptual bias, more than age, impacts on eye movements during face processing.

Consistent with the right hemispheric dominance for face processing, a left perceptual bias (LPB) is typically demonstrated by younger adults viewing faces and a left eye movement bias has also been revealed. Hemispheric asymmetry is predicted to reduce with age and older adults have demonstrated a weaker LPB, particularly when viewing time is restricted. What is currently unclear is whether age also weakens the left eye movement bias. Additionally, a right perceptual bias (RPB) for facial judgments has less frequently been demonstrated, but whether this is accompanied by a right eye movement bias has not been investigated. To address these issues older and younger adults' eye movements and gender judgments of chimeric faces were recorded in two time conditions. Age did not significantly weaken the LPB or eye movement bias; both groups looked initially to the left side of the face and made more fixations when the gender judgment was based on the left side. A positive association was found between LPB and initial saccades in the freeview condition and with all eye movements (initial saccades, number and duration of fixations) when time was restricted. The accompanying eye movement bias revealed by LPB participants contrasted with RPB participants who demonstrated no eye movement bias in either time condition. Consequently, increased age is not clearly associated with weakened perceptual and eye movement biases. Instead an eye movement bias accompanies an LPB (particularly under restricted viewing time conditions) but not an RPB.

Extrinsic tau-coupling and the regulation of interceptive reaching under varying task constraints.

We investigated a general theory accounting for the guidance of ongoing movements in an interceptive reaching task. The aim was to assess the premise of tau-coupling that the coupling constant k, the ratio of taus (τs) of motion gaps between hand and object, reflects the kinematics of the on-going movement. The spatial and temporal constraints of the interceptive action were manipulated in three task conditions. While the time dependent counterpart of k, K(t) exhibited task effects, k itself could not distinguish between task manipulations. K(t) showed large variability during the initial acceleration phase, small variability during the rest of the movement, and task dependent changes during the final deceleration phase of interception. The findings highlight the importance of clarifying what constitutes as t-coupling.

Motor control strategies and the effects of fatigue on golf putting performance.

This study investigated the strategies used by elite golfers to scale their putting actions to achieve putts of different distances. There were three aims; to determine if putting actions are scaled by manipulating swing amplitude as predicted by Craig etal. (2000), to establish the test-retest reliability of the Craig et al. model, and to evaluate whether elite golfers changed their putting scaling strategies when fatigued. Putting actions were recorded at baseline (time 1) and 6 months later (time 2) and after walking at 70% of maximum heart rate for 1 h (time 3). Participants performed a total of 80 putts which varied in distance (1 m, 2 m, 3 m, and 4 m) at time 1 and time 2, and 100 putts to the same distances when they were fatigued (time 3). Multiple regression was used to examine how the golfers systematically changed the movement control variables in the Craig etal. (2000) model to achieve golf putts of different distances. Although swing amplitude was a strong predictor of putterhead velocity at ball impact for all of the participants at baseline (time 1), each golfer systematically changed aspects of the timing of their action. A comparison of the regression models between time 1 and time 2 showed no significant changes in the scaling strategies used, indicating that the Craig etal. (2000) model had good test-retest reliability. Fatigue was associated with a decrease in the number of putts that were successfully holed and significant changes in the scaling strategies used by three of the golfers, along with a trend for increasing the putterhead velocity at ball impact. These motor control changes in performance when fatigued were evident in successful putts indicating that even when these elite golfers were able to achieve the goal of holing the putt, moderate levels of fatigue were influencing the consistency of their performance. Theoretical implications for the Craig etal. (2000) model and practical implications for elite golfers are discussed.

Corrigendum - "Motor control strategies and the effects of fatigue on golf putting performance".

[This corrects the article on p. 1005 in vol. 4, PMID: 24454298.].

Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial.

BACKGROUND: Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation. In current clinical practice, visual feedback of movement performance is often limited to the use of mirrors or video. However, neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment. However, such data are currently presented in numerical or graphical format, which is often impractical in a clinical setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation software, which is tailored for gait rehabilitation after stroke, will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients. This will result in increased patient understanding of their rehabilitation and will enable progress to be tracked in a more accessible way. METHODS: The hypothesis will be assessed using an exploratory (phase II) randomised controlled trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability (Functional Ambulation Classification of 1 or more). Participants (n = 45) will be randomised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group. The primary outcome measure will be walking speed. Secondary measures will be Functional Ambulation Category, Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal parameters associated with walking. Additional qualitative measures will be used to assess the participant's experience of the visual feedback provided in the study. DISCUSSION: Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient understanding of their rehabilitation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79005974.