The parietal mechanisms for the control of hand movement trajectory were studied by recording cell activity in area 5 of monkeys making direct reaches to visual targets and online corrections of movement trajectory, after change of target location in space. The activity of hand-related cells was fitted with a linear model including hand position, movement direction, and speed. The neural activity modulation mostly led, but also followed, hand movement. When a change of hand trajectory occurred, the pattern of activity associated with the movement to the first target evolved into that typical of the movement to the second one, thus following the corresponding variations of the hand kinematics. The visual signal concerning target location in space did not influence the firing activity associated with the direction of hand movement within the first 150 ms after target presentation. This might be the time necessary for the visuo-motor transformation underlying reaching. We conclude that online control of hand trajectory not only resides in the relationships between neural activity and kinematics, but, under specific circumstances, also on the coexistence of signals about ongoing and future hand movement direction.

The frontal mechanisms of motor intention were studied in dorsal premotor and motor cortex of monkeys making direct reaches to visual targets and online corrections of hand trajectory, whenever a change of the target's location occurred. This study and our previous one of parietal cortex (Archambault et al., 2009) provide a picture on the evolution of motor intention and online control of movement in the parietofrontal system. In frontal cortex, significant relationships were found between neural activity and hand kinematics (position, speed, and movement direction). When a change of motor intention occurred, the activity typical of the movement to the first target smoothly evolved into that associated with the movement toward the second one, as observed during direct reaches. Under these conditions, parietal cells remained a more accurate predictor of hand trajectory than frontal ones. The time lags of neural activity with hand kinematics showed that motor, premotor, and parietal cortex were activated sequentially. After the first target's presentation and its change of location, the population activity signaled the change of motor plan before the hand moved to the initial target's position. This signaling occurred earlier in premotor than in motor and parietal cortex. Thus, premotor cortex encodes a higher-order command for the correction of motor intention, while parietal cortex seems responsible for estimating the kinematics of the motor periphery, an essential step to allow motor cortex to modify the hand trajectory. This indicates that the parietofrontal system can update an original and not-yet-accomplished motor plan during its execution.

Background. Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task. Objectives. The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy. Methods. From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett's levels of evidence. A meta-analysis was performed for all three considered outcomes. Results. The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes. Conclusion. FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke.

SUMMARYTo assist physically disabled people with impaired upper limb function, we have developed a new 7-DOF exoskeleton-type robot named Motion Assistive Robotic-Exoskeleton for Superior Extremity (ETS-MARSE) to ease daily upper limb movements and to provide effective rehabilitation therapy to the superior extremity. The ETS-MARSE comprises a shoulder motion support part, an elbow and forearm motion support part, and a wrist motion support part. It is designed to be worn on the lateral side of the upper limb in order to provide naturalistic movements of the shoulder (vertical and horizontal flexion/extension and internal/external rotation), elbow (flexion/extension), forearm (pronation/supination), and wrist joint (radial/ulnar deviation and flexion/extension). This paper focuses on the modeling, design, development, and control of the ETS-MARSE. Experiments were carried out with healthy male human subjects in whom trajectory tracking in the form of passive rehabilitation exercises (i.e., pre-programmed trajectories recommended by a therapist/clinician) were carried out. Experimental results show that the ETS-MARSE can efficiently perform passive rehabilitation therapy.

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EVENS' environmental changing complexity, along with the functional tasks of far space detection and navigation can potentially be clinically relevant and warrant further empirical investigation. Findings are discussed in terms of attentional models, lateralized versus nonlateralized deficits in USN, and tasks-specific mechanisms.

Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.

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