Background. Rhythmic auditory stimulation (RAS) can influence movement during straight line walking and direction transition in individuals with Parkinson disease (PD). Objective. The authors studied whether multidirectional step training with RAS would generalize to functional gait conditions used in daily activities and balance. Methods. In a matched-pairs design, 8 patients practiced externally paced (EP) stepping (RAS group), and 8 patients practiced internally paced (IP) stepping (no RAS group) for 6 weeks. Participants were evaluated on the first and last days of practice, and 1 week, 4 weeks, and 8 weeks after practice termination. Evaluations included a primary measurementthe Dynamic Gait Index (DGI)-and secondary measurements-the Unified Parkinson's Disease Rating Scale (UPDRS), Tinetti-gait and balance tests, Timed-Up-and-Go (TUG), and Freezing of Gait Questionnaire (FOGQ). Results. The RAS group significantly improved performance on the DGI and several secondary measures, and they maintained improvements for the DGI, Tinetti, FOGQ, and balance and gait items of the UPDRS above pretraining values at least 4 weeks after practice termination. The no RAS group revealed several improvements with training but could not maintain these improvements for as long as the other group. Conclusions. Individuals with PD can generalize motor improvements achieved during multidirectional step training to contexts of functional gait and balance. Training with RAS is advantageous for enhancing functional gait improvements and the maintenance of functional gait and balance improvements over 8 weeks.

Objective: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Design: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. T etraplegia caused by injury to spinal cord has a significant disabling effect on independence in daily life. Approximately half of people with tetraplegia reported regaining arm and hand functions as the most important factor to improve their quality of life.1,2 Treatment options aiming to improve upper limb motor functions are sparse; functional electrical stimulation 3 and exercise 4 are aimed at sensory-motor recovery, whereas other treatments offer functional gains with minimal or no effects on neurorecovery. For example, neuroprostheses 5 and brain computer interface systems 6 increase motor control through alternative communication and control systems, whereas reconstructive surgery of the upper limb offers permanent changes to muscle structure. 7 There is evidence that repetitive and intensive practice can induce practice-dependent brain and spinal plasticity and that exercise intensity has a profound effect on sensory-motor recovery of patients with spinal cord injury (SCI). 8,9 In this regard, rehabilitation robots hold promise for enhancing traditional physical and/or occupational therapy. They can deliver repetitive exercises at high intensities, for extended time periods, in a consistent and precise manner. In addition, real-time measurement of performance may provide advantage to therapists to modify the therapy protocol based on improvement in performance. In this context, previous studies have reported that robotic-assisted rehabilitation can improve motor recovery after stroke and that robotic devices are safe and feasible in rehabilitation.10 Despite considerable interest in robotic gait training after SCI, 11,12 very few reports have evaluated the effect of robotic training of arm and hand function in patients with tetraplegia. [13][14][15] The current study aimed to demonstrate the feasibility and tolerability and to assess effectiveness of robotic-assisted training in improving arm and hand functions in chronic, incomplete cervical SCI. We hypothesized that intense active repetitive movement training, with a robotic device, would