Background Many persons post stroke continue to have difficulty using their more involved upper extremity and home programs may be poorly adhered to limiting the amount of practice an individual receives. More information on the experience of traditional home program and the acceptability of a novel home intervention was sought. Objective To qualitatively describe 1) upper extremity use at home, 2) previous home exercise or activity programs, and 3) the acceptability of a novel upper extremity home program, NeuroGame Therapy (NGT), that combines surface electromyography (sEMG) biofeedback and a commercial computer game. Methods A purposeful sample of ten persons with moderate to severe upper extremity motor impairment used the NGT intervention in their home for four weeks and completed nested (pre and post) one-on-one interviews. Written transcripts from the interviews were coded and themes were identified to address stated objectives. Results Participants reported that while use of their upper extremity in daily activities was recommended it occurred infrequently. Most participants described previous home programs as being non-specific, were often not carried out as recommended or were self-modified. Participants found NGT to be engaging and motivating, but reported minimal changes in the functional uses of their upper extremity. Conclusion These findings suggest that after stroke upper extremity use may be infrequent and home program approaches could be re-examined. NGT was reported to be an acceptable home intervention, but it will require further development and study to understand its value and role in post-stroke rehabilitation.

[Purpose] Measurement of posture is important for those with a clinical diagnosis as well as researchers aiming to understand the impact of faulty postures on the development of musculoskeletal disorders. A reliable, cost-effective and low tech posture measure may be beneficial for research and clinical applications. The purpose of this study was to determine rater reliability and construct validity of a posture screening mobile application in healthy young adults. [Subjects and Methods] Pictures of subjects were taken in three standing positions. Two raters independently digitized the static standing posture image twice. The app calculated posture variables, including sagittal and coronal plane translations and angulations. Intra- and inter-rater reliability were calculated using the appropriate ICC models for complete agreement. Construct validity was determined through comparison of known groups using repeated measures ANOVA. [Results] Intra-rater reliability ranged from 0.71 to 0.99. Inter-rater reliability was good to excellent for all translations. ICCs were stronger for translations versus angulations. The construct validity analysis found that the app was able to detect the change in the four variables selected. [Conclusion] The posture mobile application has demonstrated strong rater reliability and preliminary evidence of construct validity. This application may have utility in clinical and research settings.

Objective To investigate the preliminary effectiveness of surface electromyography (sEMG) biofeedback delivered via interaction with a commercial computer game to improve motor control in chronic stroke survivors. Design Single-blinded, one-group repeated measures design A1, A2, B, A3 (A=assessment, B=intervention). Setting Laboratory and participants’ homes. Participants A convenience sample of nine persons between 40–75 years of age with moderate to severe upper extremity motor impairment and at least six months post-stroke completed the study. Intervention The electromyography-controlled video game system targeted the wrist muscle activation with the goal of increasing selective muscle activation. Participants received several laboratory training sessions with the system and then were instructed to use the system at home for 45 minutes five times per week for the following four weeks. Main Outcome Measures Primary outcome measures included duration of system use, sEMG during home play and pre/post sEMG measures during active wrist motion. Secondary outcomes included kinematic analysis of movement and functional outcomes, including the Wolf Motor Function Test and the Chedoke Arm and Hand Activity Inventory-9. Results One-third of participants completed or exceeded the recommended amount of system use. Statistically significant changes were observed on both game play and pre/post sEMG outcomes. Limited carryover, however, was observed on kinematic or functional outcomes. Conclusion This preliminary investigation indicates that use of the electromyography-controlled video game impacts muscle activation. Limited changes in kinematic and activity level outcomes, however, suggest that the intervention may benefit from the inclusion of a functional activity component.

Infants’ developing motor skills—including mastery of new postures such as sitting and standing—affect opportunities for learning that facilitate cognitive development. But how infant posture affects caregiver behavior is largely unexplored. Moreover, we know little about effects of posture on learning opportunities in infants with motor delay. This study asked how infants with typical development and infants with significant motor delay use various postures during play, and whether posture is related in real time to caregiver‐provided cognitive learning opportunities. Infants were videotaped five times over the course of a year in a free play session with a caregiver, starting when they demonstrated initial sitting skills. Posture and cognitive opportunities were coded moment‐by‐moment to assess duration and temporal overlap. We found that infants with typical development and infants with motor delay displayed similar use of postures initially, but infants with typical development demonstrated more mature postures over time. We also found that for both groups of infants, caregivers were most likely to provide cognitive opportunities when infants were sitting independently, and least likely when infants were supine. Our findings highlight the importance of upright sitting in typical and atypical infant development and suggest potential areas of intervention for infants with motor delay.