Objective 1) To examine clinician adherence to a standardized assessment battery across settings (acute hospital, IRF, outpatient facility), professional disciplines (PT, OT, SLP), and time of assessment (admission, discharge/monthly), and 2) evaluate how specific implementation events affected adherence. Design Retrospective cohort study Setting Acute hospital, IRF, outpatient facility with approximately 118 clinicians (PT, OT, SLP). Participants 2194 participants with stroke who were admitted to at least one of the above settings. All persons with stroke undergo standardized clinical assessments. Interventions N/A Main Outcome Measure Adherence to Brain Recovery Core assessment battery across settings, professional disciplines and time. Visual inspections of 17 months of time-series data were conducted to see if the events (e.g. staff meetings) increased adherence ≥ 5% and if so, how long the increase lasted. Results Median adherence ranged from 0.52 to 0.88 across all settings and professional disciplines. Both the acute hospital and IRF had higher adherence than the outpatient setting (p ≤ .001) with PT having the highest adherence across all three disciplines (p < .004). Of the 25 events conducted across the 17 month period to improve adherence, 10 (40%) resulted in a ≥ 5% increase in adherence the following month, with 6 services (60%) maintaining their increased level of adherence for at least one additional month. Conclusion Actual adherence to a standardized assessment battery in clinical practice varied across settings, disciplines and time. Specific events increased adherence 40% of the time with gains maintained for greater than a month in 60%.

Chronic stroke patients with upper limb motor disabilities are now beginning to see treatment options that were not previously available. To date, the two options recently approved by the United States Food and Drug Administration include vagus nerve stimulation and brain-computer interface therapy. While the mechanisms for vagus nerve stimulation have been well defined, the mechanisms underlying brain-computer interface-driven motor rehabilitation are largely unknown. Given that cross-frequency coupling has been associated with a wide variety of higher-order functions involved in learning and memory, we hypothesized this rhythm specific mechanism would correlate with the functional improvements effected by a brain-computer interface. This study investigated whether the motor improvements in chronic stroke patients induced with a brain-computer interface therapy is associated with alterations in phase-amplitude coupling, a type of cross-frequency coupling. Seventeen chronic hemiparetic stroke patients used a robotic hand orthosis controlled with contralesional motor cortical signals measured with EEG. Patients regularly performed a therapeutic brain-computer interface task for 12 weeks. Resting state EEG recordings and motor function data were acquired before initiating brain-computer interface therapy and once every four weeks after the therapy. Changes in phase-amplitude coupling values were assessed and correlated with motor function improvements. To establish whether coupling between two different frequency bands was more functionally important than either of those rhythms alone, we calculated power spectra as well. We found that theta-gamma coupling was enhanced bilaterally at the motor areas and showed significant correlations across brain-computer interface therapy sessions. Importantly, increase in theta-gamma coupling positively correlated with motor recovery over the course of rehabilitation. The sources of theta-gamma coupling increase following brain-computer interface therapy were mostly located in the hand regions of primary motor cortex on the left and right cerebral hemispheres. Beta-gamma coupling decreased bilaterally at the frontal areas following the therapy, but these effects did not correlate with motor recovery. Alpha-gamma coupling was not altered by brain-computer interface therapy. Power spectra did not change significantly over the course of the brain-computer interface therapy. The significant functional improvement in chronic stroke patients induced by brain-computer interface therapy was strongly correlated with increased theta-gamma coupling in bihemispheric motor regions. These findings support the notion that specific cross frequency coupling dynamics in the brain likely play a mechanistic role in mediating motor recovery in the chronic phase of stroke recovery.

Participants poststroke can be classified into meaningful groups based on assessment scores from their initial physical therapist and occupational therapist evaluations. These assessment scores, in part, guide poststroke acute care discharge recommendations.

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Introduction Executive function deficits (EFD) in late life depression (LLD) are associated with poor outcomes. Dysfunction of the cognitive control network (CCN) has been posited in the pathophysiology of LLD with EFD. Methods Seventeen older adults with depression and EFD were randomized to iTBS or sham for 6 weeks. Intervention was delivered bilaterally using a recognized connectivity target. Results A total of 89% (17/19) participants completed all study procedures. No serious adverse events occurred. Pre to post‐intervention change in mean Montgomery‐Asberg‐depression scores was not different between iTBS or sham, p = 0.33. No significant group‐by‐time interaction for Montgomery‐Asberg Depression rating scale scores (F 3, 44 = 0.51; p = 0.67) was found. No significant differences were seen in the effects of time between the two groups on executive measures: Flanker scores (F 1, 14 = 0.02, p = 0.88), Dimensional‐change‐card‐sort scores F 1, 14 = 0.25, p = 0.63, and working memory scores (F 1, 14 = 0.98, p = 0.34). The Group‐by‐time interaction effect for functional connectivity (FC) within the Fronto‐parietal‐network was not significant (F 1, 14 = 0.36, p = 0.56). No significant difference in the effect‐of‐time between the two groups was found on FC within the Cingulo‐opercular‐network (F 1, 14 = 0, p = 0.98). Conclusion Bilateral iTBS is feasible in LLD. Preliminary results are unsupportive of efficacy on depression, executive function or target engagement of the CCN. A future Randomized clinical trial requires a larger sample size with stratification of cognitive and executive variables and refinement in the target engagement.