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BackgroundThere is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation. We investigated the beneficial effects of the application of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) motor training.MethodsIn total, 15 healthy, right-handed volunteers and 15 patients with stroke in the subacute stage participated. Four different conditions (A: active wrist exercise, B: VR wrist exercise, C: VR wrist exercise following anodal tDCS (1 mV, 20 min) on the left (healthy volunteer) or affected (stroke patient) primary motor cortex, and D: anodal tDCS without exercise) were provided in random order on separate days. We compared during and post-exercise corticospinal excitability under different conditions in healthy volunteers (A, B, C, D) and stroke patients (B, C, D) by measuring the changes in amplitudes of motor evoked potentials in the extensor carpi radialis muscle, elicited with single-pulse transcranial magnetic stimulation. For statistical analyses, a linear mixed model for a repeated-measures covariance pattern model with unstructured covariance within groups (healthy or stroke groups) was used.ResultsThe VR wrist exercise (B) facilitated post-exercise corticospinal excitability more than the active wrist exercise (A) or anodal tDCS without exercise (D) in healthy volunteers. Moreover, the post-exercise corticospinal facilitation after tDCS and VR exercise (C) was greater and was sustained for 20 min after exercise versus the other conditions in healthy volunteers (A, B, D) and in subacute stroke patients (B, D).ConclusionsThe combined effect of VR motor training following tDCS was synergistic and short-term corticospinal facilitation was superior to the application of VR training, active motor training, or tDCS without exercise condition. These results support the concept of combining brain stimulation with VR motor training to promote recovery after a stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-124) contains supplementary material, which is available to authorized users.

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ObjectiveTo improve lower extremity function and balance in elderly persons, we developed a novel, three-dimensional interactive augmented reality system (3D ARS). In this feasibility study, we assessed clinical and kinematic improvements, user participation, and the side effects of our system.MethodsEighteen participants (age, 56-76 years) capable of walking independently and standing on one leg were recruited. The participants received 3D ARS training during 10 sessions (30-minute duration each) for 4 weeks. Berg Balance Scale (BBS) and the Timed Up and Go (TUG) scores were obtained before and after the exercises. Outcome performance variables, including response time and success rate, and kinematic variables, such as hip and knee joint angle, were evaluated after each session.ResultsParticipants exhibited significant clinical improvements in lower extremity balance and mobility following the intervention, as shown by improved BBS and TUG scores (p<0.001). Consistent kinematic improvements in the maximum joint angles of the hip and knee were observed across sessions. Outcome performance variables, such as success rate and response time, improved gradually across sessions, for each exercise. The level of participant interest also increased across sessions (p<0.001). All participants completed the program without experiencing any adverse effects.ConclusionSubstantial clinical and kinematic improvements were observed after applying a novel 3D ARS training program, suggesting that this system can enhance lower extremity function and facilitate assessments of lower extremity kinematic capacity.

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This review presents comprehensive analyses of extant research on culture creation and change. We use the framework of culture creation and change ( Kim & Toh, 2019 ), which consists of three unique perspectives, to understand past research on the antecedents of cultures. The basis of the functionality perspective is that environmental changes shape cultures, and thus, the created cultures enable an organization to address the demands of its environments effectively. In contrast, the leadership perspective argues that leaders have disproportional influence on cultures, and when exercising such influence, they are often unsuccessful at creating functional cultures. The leadership perspective comprises two subperspectives—the leader-trait and cultural transfer perspectives. The leader-trait perspective argues that when creating cultures, leaders often overlook the functionality of cultures but rely heavily on their traits. The cultural transfer perspective suggests that leaders often recreate the cultures that they have experienced in the past. Building on this framework, we review 74 studies in 68 articles across multiple disciplines to widen our understanding of culture creation and change. We then present agendas for future research guided by a four-stage model and a theory of coordinated actions for creating functional cultures. Finally, we discuss methodological limitations in past studies and offer possible solutions.