Native diversity buffers against severity of non-native tree invasions.

Determining the drivers of non-native plant invasions is critical for managing native ecosystems and limiting the spread of invasive species1,2. Tree invasions in particular have been relatively overlooked, even though they have the potential to transform ecosystems and economies3,4. Here, leveraging global tree databases5-7, we explore how the phylogenetic and functional diversity of native tree communities, human pressure and the environment influence the establishment of non-native tree species and the subsequent invasion severity. We find that anthropogenic factors are key to predicting whether a location is invaded, but that invasion severity is underpinned by native diversity, with higher diversity predicting lower invasion severity. Temperature and precipitation emerge as strong predictors of invasion strategy, with non-native species invading successfully when they are similar to the native community in cold or dry extremes. Yet, despite the influence of these ecological forces in determining invasion strategy, we find evidence that these patterns can be obscured by human activity, with lower ecological signal in areas with higher proximity to shipping ports. Our global perspective of non-native tree invasion highlights that human drivers influence non-native tree presence, and that native phylogenetic and functional diversity have a critical role in the establishment and spread of subsequent invasions.

The number of tree species on Earth.

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are ∼73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness.

Reading tea leaves worldwide: Decoupled drivers of initial litter decomposition mass-loss rate and stabilization.

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large-scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass-loss rates and stabilization factors of plant-derived carbon, using the Tea Bag Index (TBI). The stabilization factor quantifies the degree to which easy-to-degrade components accumulate during early-stage decomposition (e.g. by environmental limitations). However, agriculture and an interaction between moisture and temperature led to a decoupling between initial mass-loss rates and stabilization, notably in colder locations. Using TBI improved mass-loss estimates of natural litter compared to models that ignored stabilization. Ignoring the transformation of dead plant material to more recalcitrant substances during early-stage decomposition, and the environmental control of this transformation, could overestimate carbon losses during early decomposition in carbon cycle models.

Action observation plus motor imagery and somatosensory discrimination training are effective non-motor approaches to improve manual dexterity.

BACKGROUND: Action observation plus motor imagery (AOMI) and somatosensory discrimination training (SSDT) represent sensory input-based approaches to train the motor system without necessarily asking subjects to perform active movements. PURPOSE: To investigate AOMI and SSDT effects compared to no intervention on manual dexterity in healthy subjects. STUDY DESIGN: Randomized controlled study. METHODS: Sixty healthy right-handed participants were randomized into AOMI, SSDT or Control (CTRL) groups. AOMI observed video-clips including right-hand dexterity tasks and concurrently performed motor imagery, SSDT performed surfaces recognition and 2-point distance discrimination tasks with the right hand, whereas CTRL underwent no intervention. A blinded physiotherapist assessed participants for manual dexterity using the Purdue Pegboard Test (Right hand-R, Left hand-L, Both hands-B, R+L+B and assembly tasks) at baseline (T0) and training end (T1). A mixed-design Analysis of Variance with Time as within-subject factor and Group as between-subject factor was used to investigate between-group differences over time. RESULTS: A Time by Group interaction and Time effect were found for R task, which increased from T0 to T1 in all groups with very large effect sizes for SSDT (d = 1.8, CI95 2.4-1.0, P < .001) and AOMI (d = 1.7, CI95 2.5-1.0, P < .001) and medium effect size for CTRL (d = 0.6, CI95 1.2-0.2, P < .001). Between-group post-hoc comparison for deltas (T1-T0) showed large effect size (d = 1.0, CI95 1.6-0.3, P = .003) in favor of SSDT and medium effect size (d = 0.7, CI95 1.4-0.1, P = .026) in favor of AOMI compared to CTRL. Time effects were found for L, B, R + L + B and assembly tasks (P < .001). CONCLUSIONS: AOMI and SSDT induced greater manual dexterity improvements than no intervention. These findings supported the role of visual and somatosensory stimuli in building a motor plan and enhancing the accuracy of hand movements. These non-motor approaches may enhance motor performance in job or hobbies requiring marked manual dexterity.

Motor resonance to non-visible postural adaptation: A novel aspect of the mirror mechanism.

The activation of the Mirror Neuron System (MNS) has been described to reflect visible movements, but not postural, non-visible, adaptations that accompany the observed movements. Since any motor act is the result of a well-tailored dialogue between these two components, we decided to investigate whether a motor resonance to nonvisible postural adaptations could be detected. Possible changes in soleus corticospinal excitability were investigated by eliciting the H-reflex during the observation of three videos, corresponding to three distinct experimental conditions: 'Chest pass', 'Standing' and 'Sitting', and comparing its size with that measured during observation of a control videoclip (a landscape). In the observed experimental conditions, the Soleus muscle has different postural roles: a dynamic role in postural adaptations during the Chest pass; a static role while Standing still; no role while Sitting. The H-reflex amplitude was significantly enhanced in the 'Chest pass' condition compared to the 'Sitting' and 'Standing' conditions. No significant difference was found between 'Sitting' and 'Standing' conditions. The increased corticospinal excitability of the Soleus during the 'Chest pass' condition suggests that the mirror mechanisms produce a resonance to postural components of an observed action, although they may not be visible. This observation highlights the fact that mirror mechanisms echo non intentional movements as well and points to a novel possible role of mirror neurons in motor recovery.

A multitaxonomic assessment of Natura 2000 effectiveness across European biogeographic regions.

The Natura 2000 (N2K) protected area (PA) network is a crucial tool to limit biodiversity loss in Europe. Despite covering 18% of the European Union's (EU) land area, its effectiveness at conserving biodiversity across taxa and biogeographic regions remains uncertain. Testing this effectiveness is, however, difficult because it requires considering the nonrandom location of PAs, and many possible confounding factors. We used propensity score matching and accounted for the confounding effects of biogeographic regions, terrain ruggedness, and land cover to assess the effectiveness of N2K PAs on the distribution of 1769 species of conservation priority in the EU's Birds and Habitats Directives, including mammals, birds, amphibians, reptiles, arthropods, fishes, mollusks, and vascular and nonvascular plants. We compared alpha, beta, and gamma diversity between matched selections of protected and unprotected areas across EU's biogeographic regions with generalized linear models, generalized mixed models, and nonparametric tests for paired samples, respectively, for each taxonomic group and for the entire set of species. PAs in N2K hosted significantly more priority species than unprotected land, but this difference was not consistent across biogeographic regions or taxa. Total alpha diversity and alpha diversity of amphibians, arthropods, birds, mammals, and vascular plants were significantly higher inside PAs than outside, except in the Boreal biogeographical region. Beta diversity was in general significantly higher inside N2K PAs than outside. Similarly, gamma diversity had the highest values inside PAs, with some exceptions in Boreal and Atlantic regions. The planned expansion of the N2K network, as dictated by the European Biodiversity Strategy for 2030, should therefore target areas in the southern part of the Boreal region where species diversity of amphibians, arthropods, birds, mammals, and vascular plants is high and species are currently underrepresented in N2K.

Análisis multitaxonómico de la efectividad de Natura 2000 en las regiones biogeográficas de Europa Resumen La red de áreas protegidas (AP) de Natura 2000 (N2K) es una herramienta importante para reducir la pérdida de biodiversidad en Europa. A pesar de que cubre el 18% del área terrestre de la UE, todavía es incierta la efectividad que tiene para conservar la biodiversidad en los taxones y las regiones biogeográficas. Sin embargo, es complicado analizar esta efectividad porque requiere considerar la ubicación no azarosa de las AP y la posibilidad de muchos factores confusos. Usamos el pareamiento por puntaje de propensión y consideramos los efectos confusos de las regiones biogeográficas, lo accidentado del terreno y la cobertura del suelo para analizar la efectividad de las AP de N2K en la distribución de 1,769 especies (mamíferos, aves, anfibios, reptiles, artrópodos, peces, moluscos y plantas vasculares y no vasculares) con prioridad de conservación en las Directivas de Aves y Hábitats de la UE. Comparamos la diversidad alfa, beta y gamma entre las selecciones pareadas de las áreas protegidas y no protegidas en las regiones biogeográficas de la UE con los modelos generalizados lineales, mixtos y pruebas no paramétricas de las muestras pareadas, respectivamente, para cada grupo taxonómico y para el conjunto completo de especies. Las áreas protegidas en N2K tuvieron una mayoría significativa de especies prioritarias en comparación con el suelo no protegido, pero esta diferencia no fue coherente entre los taxones y las regiones biogeográficas. La diversidad alfa total y la diversidad alfa de anfibios, artrópodos, aves, mamíferos y plantas vasculares fue significativamente mayor dentro de las AP que fuera de ellas, excepto en la región biogeográfica boreal. La diversidad beta fue significativamente más alta dentro de las AP de N2K que fuera de ellas. De forma similar, la diversidad gamma tuvo los valores más altos dentro de las AP, salvo algunas excepciones en las regiones boreal y atlántica. Por lo tanto, la expansión planeada de la red N2K, como dicta la Estrategia de la UE sobre Biodiversidad para 2030, debería enfocarse en las áreas del sur de la región boreal, donde es alta la diversidad de especies de anfibios, artrópodos, aves, mamíferos y plantas vasculares y cuyas especies están poco representadas dentro de N2K.

Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity.

BACKGROUND: The Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score. PURPOSE: To investigate test-retest and intra-rater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT. STUDY DESIGN: A clinical measurement study. METHODS: Twenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity. RESULTS: Test-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return (d = 1.16). CONCLUSIONS: Kinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.

Reliability of Shoulder Helical Axes During Intransitive and Transitive Upper Limb Tasks.

Shoulder complex stability can be estimated in vivo through the analysis of helical axes (HAs) dispersion during upper limb movements. The study aimed at investigating test-retest reliability of shoulder HAs dispersion parameters during upper limb tasks. Twenty healthy volunteers performed 2 intransitive (shoulder flexion and rotation) and one transitive (combing) tasks with the dominant and nondominant upper limbs during 2 recording sessions at 1-week distance. Kinematics was detected through an optoelectronic system. Mean distance and mean angle (MA) were adopted as HAs dispersion indexes. Reliability was excellent for mean distance (intraclass correlation coefficient [ICC]: .91) and MA (ICC: .92) during dominant flexion, and good for MA (ICC: .90) during nondominant flexion. Moderate reliability was found for HAs parameters during rotation (ICCs from .70 to .59), except for MA during dominant rotation where reliability was poor. Reliability was good for mean distance (ICC: .83) and moderate for MA (ICC: .67) during the dominant combing task, whereas no reliability was found during the nondominant combing task. HAs dispersion parameters revealed high reliability during simple intransitive tasks with the dominant limb. Reliability decreased with the increase in task complexity due to the increase in movement variability. HAs dispersion technique could be used to assess shoulder complex stability in patients after rehabilitation or surgery.

Mapping brain structure and function in professional fencers: A model to study training effects on central nervous system plasticity.

Brain magnetic resonance imaging (MRI) studies have shown different patterns of structural and functional reorganization in high-level athletes compared with controls, but little is known about their relationship with interlimb coordination mechanisms. To this aim, we investigated brain structural and functional differences in high-level fencers compared with nonathlete controls and the MRI substrates of interlimb coordination in elite athletes. Fourteen right-handed male fencers (median age = 22.3 years) and 15 right-handed age- and sex-matched healthy subjects (median age = 22.4 years) underwent structural and functional MRI acquisition during the execution of cyclic bimanual-movements as well as during in-phase and antiphase hand/foot-movements of the dominant-right limbs. No between-group differences were found in gray matter volumes and white matter architecture. Active-fMRI showed that controls versus fencers had higher activations in parietal and temporal areas during bimanual-task; whereas fencers versus controls had higher activations in the basal ganglia. During in-phase task, controls versus fencers showed higher activation of right cerebellum, whereas fencers had higher activity mainly in frontal areas. The functional-connectivity (FC) analysis showed that fencers versus controls had an increased FC between left motor cortex and fronto-temporal areas as well as bilateral thalami during the different tasks. Intensive and prolonged fencing activity is associated with brain functional changes mainly involving frontal regions related to high-level motor control and planning of complex tasks. These modifications are likely to reflect an optimization of brain networks involved in motor activities, including interlimb coordination tasks, occurring after intensive training.

Action Observation and Motor Imagery administered the day before surgery enhance functional recovery in patients after total hip arthroplasty: A randomized controlled trial.

OBJECTIVE: To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty. DESIGN: Randomised controlled trial. SETTING: Humanitas Clinical and Research Center, Milan, Italy. PARTICIPANTS: Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty. INTERVENTIONS: All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity. OUTCOME MEASURES: A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go - TUG) (primary outcome), maximum walking speed (10-Meter Walk Test - 10MWT), pain (Numeric Pain Rating Scale - NPRS) and fear of movement (Tampa Scale of Kinesiophobia - TSK) the day before and at four days after surgery. RESULTS: No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference -5.8 s, 95% confidence interval from -11.3 to -0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences. CONCLUSIONS: Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty.

Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review.

PURPOSE: To determine the efficacy of physiotherapy approaches used in the treatment of LSS and compare their delivery characteristics. METHODS: A systematic search was conducted using MEDLINE/PubMed, EMBASE, Scopus, PEDro, CINAHL and Web of Science databases, from inception until March 2021. Inclusion criteria were clinical diagnosis of LSS confirmed through imaging techniques, RCTs written in English comparing physiotherapy interventions among them or versus placebo or usual care without restrictions on treatment and follow-up duration, outcomes related to pain, physical function, disability and quality of life. Two independent reviewers assessed records for eligibility and methodological quality (PEDro scale) and extracted participants' characteristics, interventions details and outcome measures at each timepoint. Pooled or un-pooled findings were reported as mean difference with 95% confidence interval, depending on heterogeneity. Evidence quality was rated using the GRADE approach. RESULTS: Twelve studies (944 patients, mean PEDro score 7.6, range 5-9) were included. Three weeks of weight-supported walking improved pain and disability, while 8 weeks of aquatic exercises improved pain and walking tolerance (very low evidence). Six weeks of cycling reduced disability compared to weight-supported walking (low evidence). Six weeks of manual therapy plus exercise was not superior to supervised exercises (low evidence), but improved pain, walking tolerance, disability and quality of life compared to home/group exercises (moderate to very low evidence). Very low evidence supported 2 weeks of electromagnetic fields, whereas TENS (low evidence) and ultrasounds (very low evidence) revealed no effects. CONCLUSIONS: These findings may assist clinicians in delivering effective physiotherapy interventions in LSS patients.

Functional and structural plasticity following action observation training in multiple sclerosis.

BACKGROUND: Hand motor deficits contribute to multiple sclerosis (MS)-related disability. Action observation training (AOT) is promising to improve upper limb function in neurologic patients. OBJECTIVES: In this preliminary study, we investigated AOT effects on dominant-hand motor performance in MS patients with upper limb motor impairment and performed an explorative analysis of their anatomical and functional magnetic resonance imaging (MRI) substrates. METHODS: In total, 46 healthy controls (HC) and 41 MS patients with dominant-hand motor impairment were randomized to AOT (HC-AOT = 23; MS-AOT = 20; watching daily-life action videos and execution) or control-training (HC-Control = 23; MS-Control = 21; watching landscapes videos and execution). Behavioral, structural, and functional (at rest and during object manipulation) MRI scans were acquired before and after a 2-week training. RESULTS: After training, MS groups improved in right upper limb functions, mainly in AOT group (p from 0.02 to 0.0001). All groups showed regional increased and decreased gray matter volume, with specific AOT effects in fronto-temporal areas in MS-AOT (p < 0.001), without white matter (WM) integrity modifications. Increased and reduced recruitments of the action observation matching system and its connections in MS-AOT were found (p < 0.001). Motor improvements were correlated with volumetric and functional MRI modifications (r from -0.78 to 0.77, p < 0.001). CONCLUSION: The 10-day AOT promotes clinical improvements in MS patients through structural and functional modifications of the action observation matching system.

Niche emergence as an autocatalytic process in the evolution of ecosystems.

The utilisation of the ecospace and the change in diversity through time has been suggested to be due to the effect of niche partitioning, as a global long-term pattern in the fossil record. However, niche partitioning, as a way to coexist, could be a limited means to share the environmental resources and condition during evolutionary time. In fact, a physical limit impedes a high partitioning without a high restriction of the niche's variables. Here, we propose that niche emergence, rather than niche partitioning, is what mostly drives ecological diversity. In particular, we view ecosystems in terms of autocatalytic sets: catalytically closed and self-sustaining reaction (or interaction) networks. We provide some examples of such ecological autocatalytic networks, how this can give rise to an expanding process of niche emergence (both in time and space), and how these networks have evolved over time (so-called evoRAFs). Furthermore, we use the autocatalytic set formalism to show that it can be expected to observe a power-law in the size distribution of extinction events in ecosystems. In short, we elaborate on our earlier argument that new species create new niches, and that biodiversity is therefore an autocatalytic process.

The association between patient participation and functional gain following inpatient rehabilitation.

OBJECTIVES: To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. METHODS: All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. RESULT: A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). CONCLUSION: This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

An integrated pan-tropical biomass map using multiple reference datasets.

We combined two existing datasets of vegetation aboveground biomass (AGB) (Proceedings of the National Academy of Sciences of the United States of America, 108, 2011, 9899; Nature Climate Change, 2, 2012, 182) into a pan-tropical AGB map at 1-km resolution using an independent reference dataset of field observations and locally calibrated high-resolution biomass maps, harmonized and upscaled to 14 477 1-km AGB estimates. Our data fusion approach uses bias removal and weighted linear averaging that incorporates and spatializes the biomass patterns indicated by the reference data. The method was applied independently in areas (strata) with homogeneous error patterns of the input (Saatchi and Baccini) maps, which were estimated from the reference data and additional covariates. Based on the fused map, we estimated AGB stock for the tropics (23.4 N-23.4 S) of 375 Pg dry mass, 9-18% lower than the Saatchi and Baccini estimates. The fused map also showed differing spatial patterns of AGB over large areas, with higher AGB density in the dense forest areas in the Congo basin, Eastern Amazon and South-East Asia, and lower values in Central America and in most dry vegetation areas of Africa than either of the input maps. The validation exercise, based on 2118 estimates from the reference dataset not used in the fusion process, showed that the fused map had a RMSE 15-21% lower than that of the input maps and, most importantly, nearly unbiased estimates (mean bias 5 Mg dry mass ha(-1) vs. 21 and 28 Mg ha(-1) for the input maps). The fusion method can be applied at any scale including the policy-relevant national level, where it can provide improved biomass estimates by integrating existing regional biomass maps as input maps and additional, country-specific reference datasets.

Brain structural and functional connectivity in Parkinson's disease with freezing of gait.

OBJECTIVE: To use a multimodal approach to assess brain structural pathways and resting state (RS) functional connectivity abnormalities in patients with Parkinson's disease and freezing of gait (PD-FoG). METHODS: T1-weighted, diffusion tensor (DT) MRI and RS functional MRI (fMRI) were obtained from 22 PD-FoG patients and 35 controls on a 3.0 T MR scanner. Patients underwent clinical, motor, and neuropsychological evaluations. Gray matter (GM) volumes and white matter (WM) damage were assessed using voxel based morphometry and tract-based spatial statistics, respectively. The pedunculopontine tract (PPT) was studied using tractography. RS fMRI data were analyzed using a model free approach investigating the main sensorimotor and cognitive brain networks. Multiple regression models were performed to assess the relationships between structural, functional, and clinical/cognitive variables. Analysis of GM and WM structural abnormalities was replicated in an independent sample including 28 PD-FoG patients, 25 PD patients without FoG, and 30 healthy controls who performed MRI scans on a 1.5 T scanner. RESULTS: Compared with controls, no GM atrophy was found in PD-FoG cases. PD-FoG patients showed WM damage of the PPT, corpus callosum, corticospinal tract, cingulum, superior longitudinal fasciculus, and WM underneath the primary motor, premotor, prefrontal, orbitofrontal, and inferior parietal cortices, bilaterally. In PD-FoG, right PTT damage was associated with a greater disease severity. Analysis on the independent PD sample showed similar findings in PD-FoG patients relative to controls as well as WM damage of the genu and body of the corpus callosum and right parietal WM in PD-FoG relative to PD no-FoG patients. RS fMRI analysis showed that PD-FoG is associated with a decreased functional connectivity of the primary motor cortex and supplementary motor area bilaterally in the sensorimotor network, frontoparietal regions in the default mode network, and occipital cortex in the visual associative network. CONCLUSIONS: This study suggests that FoG in PD can be the result of a poor structural and functional integration between motor and extramotor (cognitive) neural systems.

Constraint-induced movement therapy for upper extremities in people with stroke.

BACKGROUND: In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. OBJECTIVES: To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). SELECTION CRITERIA: Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS: One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. MAIN RESULTS: We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. AUTHORS' CONCLUSIONS: CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person's capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required.