BACKGROUND: Transcranial direct current stimulation (tDCS) may provide a safe, non-invasive technique for modulating neural excitability during neurorehabilitation. OBJECTIVE: 1) Assess feasibility and potential effectiveness of tDCS as an adjunct to standard upper extremity (UE) physical therapy (PT) for motor impairments resulting from neurological insult. 2) Determine sustainability of improvements over a six month period. METHODS: Five participants with chronic neurologic insult (stroke or traumatic brain injury > 6 months prior) completed 24 sessions (40 minutes, three times/week) of UE-PT combined with bihemispheric tDCS delivered at 1.5 mA over the motor cortex during the first 15 minutes of each PT session. Outcomes were assessed using clinical (UE Fugl-Meyer, Purdue Pegboard, Box and Block, Stroke Impact Scale) and robotic (unimanual and bimanual motor control) measures. Change in scores and associated effects sizes from Pre-test to Post-test and a six month Follow-up were calculated for each participant and group as a whole. RESULTS: Scores on UE Fugl-Meyer, Box and Block, Purdue Pegboard, Stroke Impact Scale, and robotic measures improved from Pre-to Post-test. Improvements on UE Fugl-Meyer, Box and Block, and robotic measures were largely sustained at six months. CONCLUSIONS: Combining bihemispheric tDCS with UE-PT in individuals with neurological insult warrants further investigation.

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Objective To determine the feasibility and impact of different dosages of Intensive Mobility Training (IMT) on mobility, balance, and gait speed in individuals with chronic traumatic brain injury (TBI). Design Prospective, single group design with 3-month follow-up Setting University research lab Participants : A volunteer sample of 10 participants with chronic TBI (≥3 months post-TBI, able to ambulate 3.05 m with or without assistance); median age 35.4 (IQR: 23.5, 46) years, median time post-TBI 9.91 (IQR: 6.3, 14.2) years. Follow-up data was collected for all participants. Interventions Twenty days (5 days/week × 4 weeks),150 minutes/day of repetitive, task-specific training equally divided among 1) balance, 2) gait training, and 3) strength, coordination, and range. Main Outcome Measures Pain and fatigue were recorded before and after each session to assess feasibility. Treatment outcomes were assessed before training (pre), after 10 sessions (interim), after 20 sessions (post), and 3 months follow-up and included the Berg Balance Scale and gait speed. Results Participants averaged 150.1 (2.7) minutes/session. Median pre-session and post-session pain scores were 0/10 for 20 sessions; median pre-session fatigue scores ranged 0-2.5/10, post-session scores ranged 3-5.5/10. Four outcome measures demonstrated significant improvement pre-test to interim, with 7/10 participants exceeding the minimal detectable change (MDC) for fast walking speed. At post-test, two additional measures were significant, with more participants exceeding MDCs. Changes in fast walking speed and Timed Up and Go were significant at follow-up. Conclusions Limited fluctuations in pain and fatigue scores indicate feasibility of IMT in this population. Participants demonstrated improvements in walking speed, mobility, and balance post-intervention, and maintained gains in fast walking speed and mobility at three months.

Background: Many survivors of stroke face chronic disability and increased risk for recurrent stroke. Regular physical activity can reduce these risk factors and improve cardiovascular fitness. Most survivors of stroke face barriers to exercise, including lack of access to programs; as a result, most are sedentary. Objective: Pilot the Neurological Exercise Training (NExT) program or survivors of stroke for attendance, safety, and effectiveness. Methods: The NExT program was designed to promote self-directed exercise in a safe, accessible environment. Six participants attended as desired during open gym hours over two exercise periods per week totalling 19 weeks. After, participants were encouraged to continue exercise away from the gym for 20 weeks. Practicability of the program was assessed through safety, attendance, exercise intensity, and perception of the program. Pilot effectiveness measures were performed at five time points and effect sizes were generated. Results: Attendance averaged 76% (12%) of possible sessions with an average duration of 62 (SD 11.3) minutes. Effectiveness measures had positive effect sizes after 19 weeks of the NExT program, but these benefits were lost after 20-weeks (cohen's d, mobility=0.67 to −0.22, balance= 0.57 to −1.22, strength= 0.41 to −0.30, endurance= 0.09 to −0.19 and fatigue= 1.02 to −0.57). Conclusion: Results demonstrate that a community-based gym that is accessible for survivors of stroke will be well attended and perceived as beneficial. Pilot data suggests positive changes in *

Background Clinicians and researchers have used bathroom scales, balance performance monitors with feedback, postural scale analysis, and force platforms to evaluate weight bearing asymmetry (WBA). Now video game consoles offer a novel alternative for assessing this construct. By using specialized software, the Nintendo Wii Fit balance board can provide reliable measurements of WBA in healthy, young adults. However, reliability of measurements obtained using only the factory settings to assess WBA in older adults and individuals with stroke has not been established. Purpose To determine whether measurements of WBA obtained using the Nintendo Wii Fit balance board and default settings are reliable in older adults and individuals with stroke. Methods Weight bearing asymmetry was assessed using the Nintendo Wii Fit balance board in 2 groups of participants—individuals older than 65 years (n = 41) and individuals with stroke (n = 41). Participants were given a standardized set of instructions and were not provided auditory or visual feedback. Two trials were performed. Intraclass correlation coefficients (ICC), standard error of measure (SEM), and minimal detectable change (MDC) scores were determined for each group. Results The ICC for the older adults sample was 0.59 (0.35–0.76) with SEM95= 6.2% and MDC95= 8.8%. The ICC for the sample including individuals with stroke was 0.60 (0.47–0.70) with SEM95= 9.6% and MDC95= 13.6%. Discussion Although measurements of WBA obtained using the Nintendo Wii Fit balance board, and its default factory settings, demonstrate moderate reliability in older adults and individuals with stroke, the relatively high associated SEM and MDC values substantially reduce the clinical utility of the Nintendo Wii Fit balance board as an assessment tool for WBA. Conclusions Weight bearing asymmetry cannot be measured reliably in older adults and individuals with stroke using the Nintendo Wii Fit balance board without the use of specialized software.