Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke.Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function.Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09– 0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26– 0.65; p <  0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04– 0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16– 0.79; p = 0.14).Conclusion: These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.

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Tonic stretch reflex threshold interevaluator reliability for evaluating stroke-related plantar-flexor spasticity was very good. The TSRT is a reliable measure of spasticity. More information may be gained by combining the TSRT measurement with a measure of velocity-dependent resistance.

Arm movement deficits can be identified when complex tasks are evaluated. Deficits in higher-order motor function such as obstacle avoidance behavior may decrease actual arm use in individuals with mild-to-moderate hemiparesis and should be evaluated in routine clinical practice.

This study addresses the question of how posture and movement are oriented with respect to the direction of gravity. It is suggested that neural control levels coordinate spatial thresholds at which multiple muscles begin to be activated to specify a referent body orientation (RO) at which muscle activity is minimized. Under the influence of gravity, the body is deflected from the RO to an actual orientation (AO) until the emerging muscle activity and forces begin to balance gravitational forces and maintain body stability. We assumed that (1) during quiet standing on differently tilted surfaces, the same RO and thus AO can be maintained by adjusting activation thresholds of ankle muscles according to the surface tilt angle; (2) intentional forward body leaning results from monotonic ramp-and-hold shifts in the RO; (3) rhythmic oscillation of the RO about the ankle joints during standing results in body swaying. At certain sway phases, the AO and RO may transiently overlap, resulting in minima in the activity of multiple muscles across the body. EMG kinematic patterns of the 3 tasks were recorded and explained based on the RO concept that implies that these patterns emerge due to referent control without being pre-programmed. We also confirmed the predicted occurrence of minima in the activity of multiple muscles at specific body configurations during swaying. Results re-affirm previous rejections of model-based computational theories of motor control. The role of different descending systems in the referent control of posture and movement in the gravitational field is considered.

Purpose: The purpose of this study was to understand current trends in rehabilitation practice regarding spasticity assessment and treatment. Method: The clinical practices of Canadian physiotherapists and occupational therapists in assessing and treating spasticity were investigated using a selfadministered, Web-based questionnaire (cross-sectional design). Experienced clinicians developed the questionnaire, which surveyed socio-demographic characteristics, work environment, and clinician satisfaction with spasticity assessments and preferences for treatment. Results: A total of 317 clinicians (204 physiotherapists and 113 occupational therapists) completed the questionnaire. The majority of participants reported that using valid and reliable outcome measures to assess spasticity was important (91.1%). Most clinicians indicated using a combination of spasticity assessments, and their level of satisfaction with these assessments was very high. All clinicians believed that spasticity should be evaluated by rehabilitation professionals, and most indicated that it should be assessed by more than one professional. Although 83.8% indicated that spasticity should be tested on admission, a much lower percentage believed that it should be evaluated throughout rehabilitation. Most clinicians (92.2%) reported using multiple treatment modalities for spasticity. Conclusions: This study is the first to document clinicians' practices regarding spasticity assessment and treatment. A better understanding of current trends in physiotherapy and occupational therapy will help in tailoring strategies to improve practice.

Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same motor goals (motor equivalence). Compensatory movement patterns such as excessive trunk displacement in stroke subjects during reaching can be viewed as a consequence of the motor equivalent process to accomplish a task despite limited available ranges in some joints. However, despite compensations, the ability to adapt reaching performance when perturbations occur may still be limited when condition-specific changes of joint angles are required. We addressed this hypothesis in individuals with and without stroke for reaching a target placed beyond arm reach in standing while flexing the hips (free-hip condition). In randomly selected trials, hip flexion was unexpectedly blocked, forcing subjects to take a step (blocked-hip condition). In additional trials, subjects took an intentional step while reaching the target (intentional-step condition). In blocked-hip trials, healthy subjects maintained smooth and precise endpoint trajectories by adapting temporal and spatial interjoint coordination to neutralize the effect of the perturbation. However, the ability to produce motor equivalent solutions was reduced in subjects with stroke, evidenced by substantial overshoot errors in endpoint position, reduced movement smoothness and less adaptive elbow-shoulder interjoint coordination. Movement adaptability was more limited in stroke subjects who used more compensatory movements for unperturbed reaching. Results suggest that subjects with mild-to-moderate stroke only partially adapted arm joint movements to maintain reaching performance. Therapeutic efforts to enhance the ability of individuals with stroke to find a larger number of task-relevant motor solutions (adaptability) may improve upper limb recovery.