Forced exercise has resulted in neuroprotective effects and improved motor function in animal studies. These promising results have not yet been translated fully to humans with Parkinson's disease (PD), as traditional exercise interventions have not yielded global improvements in function. A novel forced exercise intervention is described that has resulted in improved motor function and central nervous system function in PD patients.

OBJECTIVE. The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke. METHOD. A multisite randomized controlled clinical trial was completed with 99 people <6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy + home exercise program, and participated in an 8-wk home intervention. RESULTS. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups. CONCLUSION. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke.

Background Geographical location, socioeconomic status and logistics surrounding transportation impede access of post-stroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing for the remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP), was incorporated within a home exercise program (HEP) to improve upper extremity functional capabilities post-stroke. Objective To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months post-stroke and characterized as underserved. Methods In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to upper extremity rehabilitation were randomized to the: 1) experimental group which received combined HEP and HMP for 3 hrs/day x 5 days x 8 weeks; or 2) control group which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl Meyer Assessment (upper extremity) were primary and secondary outcome measures respectively, undertaken before and after the interventions. Results Both groups demonstrated improvement across all upper extremity outcomes. Conclusions Robotic+HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time, additional research is necessary to determine appropriate dosage of HMP and HEP.

Context: Force platforms and 3-dimensional motion-capture systems provide an accurate method of quantifying postural stability. Substantial cost, space, time to administer, and need for trained personnel limit widespread use of biomechanical techniques in the assessment of postural stability in clinical or field environments.Objective: To determine whether accelerometer and gyroscope data sampled from a consumer electronics device (iPad2) provide sufficient resolution of center-of-gravity (COG) movements to accurately quantify postural stability in healthy young people.Design: Controlled laboratory study. Setting: Research laboratory in an academic medical center.Patients or Other Participants: A total of 49 healthy individuals (age ¼ 19.5 6 3.1 years, height ¼ 167.7 6 13.2 cm, mass ¼ 68.5 6 17.5 kg).Intervention(s): Participants completed the NeuroCom Sensory Organization Test (SOT) with an iPad2 affixed at the sacral level.Main Outcome Measure(s): Primary outcomes were equilibrium scores from both systems and the time series of the angular displacement of the anteroposterior COG sway during each trial. A Bland-Altman assessment for agreement was used to compare equilibrium scores produced by the NeuroCom and iPad2 devices. Limits of agreement was defined as the mean bias (NeuroCom À iPad) 6 2 standard deviations. Mean absolute percentage error and median difference between the NeuroCom and iPad2 measurements were used to evaluate how closely the real-time COG sway measured by the 2 systems tracked each other.Results: The limits between the 2 devices ranged from À0.58 to 0.58 in SOT condition 1 to À2.98 to 1.38 in SOT condition 5. The largest absolute value of the measurement error within the 95% confidence intervals for all conditions was 2.98. The mean absolute percentage error analysis indicated that the iPad2 tracked NeuroCom COG with an average error ranging from 5.87% to 10.42% of the NeuroCom measurement across SOT conditions.Conclusions: The iPad2 hardware provided data of sufficient precision and accuracy to quantify postural stability. Accuracy, portability, and affordability make using the iPad2 a reasonable approach for assessing postural stability in clinical and field environments.Key Words: concussions, motor function, motor control, biomechanics Key PointsThe accelerometer and gyroscope within the iPad2 provided data of sufficient quantity and quality to enable accurate evaluation of postural stability. The accuracy, portability, availability, and affordability of mobile devices can enable health care providers in various clinical and field settings to evaluate postural stability in athletes. To improve clinical outcomes, mobile devices can be a mechanism by which sophisticated biomechanical algorithms are translated to the broader field of athletic trainers and clinical teams treating patients with concussions. The accuracy and reliability of mobile devices must be validated before these systems are used to assess cognitive or motor function.

Purpose The aim of this project was to develop a biomechanically based quantification of the Balance Error Scoring System (BESS) using data derived from the accelerometer and gyroscope of a mobile tablet device. Methods Thirty-two healthy youth and adults completed the BESS while an iPad was positioned at the sacrum. Data from the iPad data was compared to position data gathered from a 3D motion capture system. Peak-to-peak (P2P), normalized path length (NPL), and root mean squared (RMS) were calculated for each system and compared. Additionally, a 95% ellipsoid volume, iBESS volume, was calculated using center of mass (COM) movements in the anterior-posterior (AP), mediolateral (ML), and trunk rotation planes of movement to provide a comprehensive, 3-dimensional metric of postural stability. Results Across all kinematic outcomes, data from the iPad were significantly correlated with the same outcomes derived from the motion capture system (Rho range: 0.37- 0.94, p<0.05). The iBESS volume metric was able to detect a difference in postural stability across stance and surface, showing a significant increase in volume in increasingly difficult conditions, while traditional error scoring was not as sensitive to these factors. Conclusions The kinematic data provided by the iPad is of sufficient quality relative to motion capture data to accurately quantify postural stability in healthy young adults. The iBESS volume provides a more sensitive measure of postural stability than error scoring alone, particularly in conditions 1 and 4, which often suffer from floor effects, and condition 5, which can experience ceiling effects. The iBESS metric is ideally suited for clinical and in the field applications in which characterizing postural stability is of interest.

Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke. Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke. Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks. Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group ( P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times ( P ≤ .01 for all observations). Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

Objective: The aim of this project was to determine the effects of lower extremity aerobic exercise coupled with upper extremity repetitive task practice (RTP) on health related quality of life (HRQOL) and depressive symptomology in individuals with chronic stroke. Design: Secondary analysis of data from two randomized controlled trials. Setting: Research laboratory. Participants: Individuals (N=40) with chronic stroke. Interventions: Participants received one of the following interventions: forced exercise + RTP (FE+RTP, n=16), voluntary exercise + RTP (VE+RTP, n=16), or stroke education + RTP (EDU +RTP, n=8). All groups completed 24 sessions, each session lasting 90 minutes. Main Outcome Measure: The Center for Epidemiological Studies-Depression Scale (CES-D) and Stroke Impact Scale (SIS) were used to assess depressive symptomology and HRQOL. Results: There were no significant group-by-time interactions for any of the SIS domains or composite scores. Examining the individual groups following the intervention, those in the FE +RTP and VE+RTP groups demonstrated significant improvements in the following SIS domains: strength, mobility, hand function, activities of daily living, and the physical composite. Additionally, the FE+RTP group demonstrated significant improvements in memory, cognitive

Objective To determine the accuracy of inertial measurement unit data from a mobile device using the mobile device relative to posturography to quantify postural stability in individuals with Parkinson’s disease (PD). Design Criterion standard. Setting Motor control laboratory at Cleveland Clinic. Participants Fourteen mild to moderate individuals with PD and 14 healthy age-matched community dwelling controls completed the project. Interventions Not applicable. Main Outcome Measures Center of mass (COM) acceleration measures were compared between the mobile device and NeuroCom force platform to determine accuracy of mobile device measurements during performance of the Sensory Organization Test (SOT). Analyses examined test-retest reliability for both systems and sensitivity of: 1) the Equilibrium Score from the SOT and 2) COM acceleration measures from the force platform and mobile device to quantify postural stability across populations. Results Metrics of COM acceleration from inertial measurement unit data and NeuroCom force platform were significantly correlated across balance conditions and groups (Pearson’s r ranged from 0.35 to 0.97). The SOT Equilibrium Scores failed to discriminate individuals with PD and controls. However, the multi-planar measures of COM acceleration from the mobile device exhibited good to excellent reliability across SOT conditions and were able to discriminate individuals with PD and controls in conditions with the greatest balance demands. Conclusions Metrics employing medial-lateral movement produce a more sensitive outcome than the Equilibrium Score in identifying postural instability associated with PD. Overall, the output from the mobile device provides an accurate and reliable method of rapidly quantifying balance in individuals with PD. The portable and affordable nature of a mobile device with the application make it ideally suited to utilize biomechanical data to aid in clinical decision-making.