Improving the sensitivity of the Barthel Index for stroke rehabilitation. Leveraging this innate and robust motor learning circuitry, harnessing brain plasticity (Thakor, 2013), may be the next step toward improve patient outcomes. The x-axis shows the RMT (left) and AMT (right). The role of brain oscillations in post-stroke motor recovery: An overview. The National Institutes of Health Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify impairments caused by a stroke (Ortiz and Sacco, 2008). (2012) presented images of manipulable objects with congruent and incongruent grips while recording EEG responses. -. (2013). *Post hoc LSD analysis showed a statistically significant difference (p < 0.05). Furthermore, this pattern of desynchronization is not predicted to be robust at other sites across the scalp. For the measurement of RMT, the subject relaxed and EMG silence was monitored. Audio Electroacoust 1967, 15: 70-73. The first BCI session was focused on assisting the participant to comprehend and engage the BCI device and protocol. eCollection 2022. ERD/ERS was calculated for mean activity in every 100 ms time window after stimulus onset on the smoothed ERD/ERS traces. eCollection 2021. The ERD is suggested to be generated by the neural interconnection of the feedback loop involving the thalamo-cortical or cortico-cortical loop [2, 19]. (3) Cursor task with adjuvant stimuli (10 trials with adjuvant stimuli). Examples of the stimuli used in the experiment. In the incongruent grip condition, a grip was chosen that was appropriate for another real object, so that congruent and incongruent grips did not differ in their visual properties across the complete set of stimuli. Given the heterogeneity of lesion location in the existing sample set, source localization might be premature. A significant 3-way interaction [hemisphere object type grip; F(1, 16) = 8.125, p = 0.012] and main effect of object type [object > non-object; F(1, 16) = 4.713, p = 0.045] was observed in the 100200 ms time window in the 810 Hz mu band. Mathiowetz V., Weber K., Kashman N., Volland G. (1985). and the formation of central to peripheral connections. https://doi.org/10.1186/1743-0003-7-27, DOI: https://doi.org/10.1186/1743-0003-7-27. (2010). BCI intervention block design. Loss of motor function is a common deficit following stroke insult and often manifests as persistent upper extremity (UE) disability which can affect a survivors ability to participate in activities of daily living. Electroencephalogr Clin Neurophysiol 1991, 79: 81-93. For example, lesion load is a limiting factor as sufficient existing neural-architecture is needed for motor recovery to occur (Power et al., 2011). Rewards of tactile, kinesthetic feedback to the system and the visual revelation of a previously impaired appendage now voluntarily animated may prove powerful (Moe and Post, 1962; Krafi et al., 1992; Popovic et al., 2009; Howlett et al., 2015) reinforces. BCI cap array. Little evidence has thus far been offered to suggest an optimal BCI regimen. The primary outcome measure was the ARAT. RC1 MH090912/MH/NIMH NIH HHS/United States, UL1 TR000427/TR/NCATS NIH HHS/United States, R01 NS105646/NS/NINDS NIH HHS/United States, R01 EB000856/EB/NIBIB NIH HHS/United States, K23 NS086852/NS/NINDS NIH HHS/United States, UL1 TR002373/TR/NCATS NIH HHS/United States, T32 EB011434/EB/NIBIB NIH HHS/United States, R01 EB009103/EB/NIBIB NIH HHS/United States, T32 GM008692/GM/NIGMS NIH HHS/United States, NCI CPTC Antibody Characterization Program, Ang K., Guan C. (2013). Perry and Bentin (2009) have also shown that mu rhythm desynchronization is larger when a hand grasps an object compared to when repetitive hand movements are made. Automatic motor cortex activation for natural as compared to awkward grips of a manipulable object, Event-related cortical desynchronization detected by power measurements of scalp EEG, Evaluation of event-related desynchronization (ERD) preceding and following voluntary self-paced movement, Event-related synchronization of mu rhythm in the EEG over the cortical hand area in man. 10.1016/0013-4694(78)90107-4, Kozelka JW, Pedley TA: Beta and mu rhythms. Objects and non-objects were gripped congruently or incongruently. Assist. The authors work hard to best minimize differences in acquisition of study measures through extensive and repeated training of personnel. A further possibility, though, is that the body parts evoke a motor response that is modulated by whether the objects are gripped appropriately or inappropriately for action. (2016). Evidence for altered upper extremity muscle synergies in chronic stroke survivors with mild and moderate impairment. (2004) found that mu rhythm was more suppressed when participants grasped an object compared to when a grasp was not object-directed. Thus, it is regarded as "idling" rhythm of the cortical sensory region. The tDCS was applied for 10 min through rectangular saline-soaked sponge electrodes (50 70 mm2) with a battery-driven stimulator (CX-6650, Rolf Schneider Electronics, Gleichen, Germany). Bookshelf Panel (A) reflects the condition with congruent grips to objects and shows an extended period of ERD activation. Changes of mu ERD during the motor imagery of the right hand grasping something after the three types of tDCS (anodal, cathodal, and sham). Patients with UE motor impairment traditionally receive rehabilitation regimens that involve passive, repetitive movement of the impaired limb without directly linking brain activity to these movements (Dromerick et al., 2009). Goldman R. I., Stern J. M., Engel J., Jr., Cohen M. S. (2002). contributions to predict recovery potential and more efficaciously prescribe BCI intervention as therapy. Jun Matsumoto, Toshiyuki Fujiwara contributed equally to this work. By 2050, stroke burden on the United States economy will approach $2.2 trillion (Benjamin et al., 2017). Technol. The mu rhythm's geometric source character is that of a dipole, with the dipole moment pointing perpendicular to the folded cortical surface. Anodal, cathodal, and sham tDCS were tested in each subject with a randomized sequence on different days. Asterisk denotes statistical significance from a one-tailed paired t-test (p < 0.05). PubMed . Inter-rater reliability and validity of the action research arm test in stroke patients. the display of certain parts of an article in other eReaders. Careers, Edited by: Ioan Opris, University of Miami, United States, Reviewed by: Ranganatha Sitaram, Pontifical Catholic University of Chile, Chile; David Thomas Bundy, University of Kansas Medical Center Research Institute, United States, This article was submitted to Neural Technology, a section of the journal Frontiers in Neuroscience. In general our results are compatible for a broad set of other data. Along with the EEG-BCI-FES intervention sessions, subjects also receive fMRI and behavioral testing at four time points: prior to the first EEG-BCI-FES intervention session (baseline), after the first few weeks of intervention (midpoint), following the final intervention session (endpoint), and again 1 month after the endpoint assessment (follow-up). government site. The non-objects were all visually inspected and judged to be usable. Every object was photographed with a congruent grip and an incongruent grip, and every non-object was edited to include either a congruent or an incongruent grip depending on the relations between the hand and the handle. about navigating our updated article layout. volume7, Articlenumber:27 (2010) Provided by the Springer Nature SharedIt content-sharing initiative. Determining optimal mobile neurofeedback methods for motor neurorehabilitation in children and adults with non-progressive neurological disorders: a scoping review. These data suggest that part of the action-based effects may reflect enhanced visual processing, perhaps because interacting objects are visually familiar. PLoS ONE 3:e2113. Cheng Y, Lee P-L, Yang C-Y et al (2008) Gender differences in the mu rhythm of the human mirror-neuron system. An EEG-based brain-computer interface for cursor control. In this example the stimulus is in the congruent grip condition. Funding. We also examined correlations between the EEG data and behavior, using Pearson product moment correlations and Bonferroni correction for multiple comparisons. Ana ba da shawarar haa kwamfutar da aka lullue da fim gaba aya, ba tare da taunawa ko murushewa ba, tare da isasshen adadin ruwa. Online electroencephalograms (EEGs) were measured while participants performed the task. The input signal, initially set to zero, was adjusted by steps of 0.5 mA, unless the stimulation became uncomfortable for the subject. Subjects were given no feedback about EEG changes to avoid a learning effect [12]. Six healthy male subjects (age 30 2 years, all right-handed) participated in this study after giving written informed consent. Our finding that mu rhythm de-synchronization correlated with object decision responses also matches previous findings such as those of Borghi et al. Electrode array and cap arrangement for all n = 21 participants. (2015). It is thought that there might be some relationship between cortical excitability and mu ERD. The BCI system and intervention sequence were consistent with those previously described (Wilson et al., 2012; Song et al., 2014, 2015; Young et al., 2014a,b,c) using BCI2000 software (Schalk et al., 2004) version 2 with in-house modifications for input from a 16-channel EEG cap and amplifier (Guger Technologies) and integration with the ball and target gaming visual display as well as tongue stimulation (TDU 01.30 Wicab Inc.) (Kaczmarek, 2011) and functional electrical stimulation (FES) (LG-7500, LGMedSupply; Arduino 1.0.4). In normal effortful movement, Mu rhythms of the contralateral cortex are desynchronized and attenuated (ERD) as movements are planned and executed (Pfurtscheller et al., 1997). During each of the screening phases (pre- and post-therapy) EEG data were collected in four separate runs. Action observation can prime visual object recognition. Each EEG-BCI-FES intervention session consisted of multiple runs of the Cursor Task (mean of 31.3 10.5 runs per session), about 1/3rd of which included only visual feedback, and roughly two thirds of which were comprised of BCI facilitated functional electric stimulation of the impaired hand and lingual electrotactile stimulation through a tongue display unit (TDU) (Kaczmarek, 2011; Wilson et al., 2012) (Figure 2). Post-stroke neuronal loss alters recruitment of downstream muscle synergies (Cheung et al., 2009), and alters a synergys internal structure (Roh et al., 2013) depending on stroke severity (Roh et al., 2015). Maladaptive associations may simply need more time to be pruned away and relevant adaptive associations strengthened by increased and more highly structured reinforcement (Gazzaniga et al., 2009; Wenger et al., 2017). Emilia Zabielska-Mendyk, Piotr Francuz, Marta . Using mu rhythm desynchronization to measure mirror neuron activity in infants. Also the power of mu activity correlated with RTs to congruently gripped objects. LW was involved in staff training, data collection, data processing, data analysis, interpreting data, and writing of the manuscript. Either approach utilizes essentially overlapping neural architecture to provide input signals (electrophysiological recordings by the EEG cap) to the BCI. The secondary measures include: The Stroke-Impact Scale (SIS), widely used to measure quality of life in stroke survivors that consists of 8 dimensions and a composite disability score (Vellone et al., 2015). Two basic strategies in SMR-based control have been introduced for motor rehabilitation in stroke patients: motor imagery (Wolpaw et al., 1991; Ortner et al., 2012; Irimia et al., 2016) and attempted movement-based approaches (Wolpaw et al., 1991; Schalk et al., 2004; Young et al., 2014a,b,c). Functional dissociation of lower and upper frequency mu rhythms in relation to voluntary limb movement. Action relationships concatenate representations of separate objects in the ventral visual system. despite the grip responses being irrelevant to the task, mu rhythm activity on the scalp over motor and pre-motor cortex was sensitive to the congruency of the hand gripin particular the event-related desynchronization of the mu rhythm was more pronounced for familiar objects grasped with an appropriate grip than for objects given an TF contributed to conception and design, carried out the studies, analysis and interpretation of data, and drafted the manuscript. This is an on-going study in its seventh year of data acquisition and participant enrollment. Electroencephalograms (EEGs) were recorded near the left M1. OT carried out the studies, acquisition of data and analysis of data. Repeated measure ANOVA showed no significant difference among mu ERD before each stimulation (anodal, cathodal, and sham) (F2,10 = 0.39, p = 0.68). A., Walton L. M., Tyler M., Williams J. Their accuracy was also worse for non-objects gripped congruently than objects gripped congruently (t = 3.756, p = 0.002). Muthukumaraswamy S. D., Johnson B. W. (2004). 10.1002/hbm.20585, Article There was also a significant interaction between object type and grip [F(1, 16) = 12.161, p = 0.003]. One possibility, then, is that the sight of body parts interacting with objects leads to a similar direct enhancement of visual processing. (1) Pre-screening (two actual movement trials, two imagined movement trials). Wilson J. Motor attempt (MA)/motor imagery (MI)-based brain-computer interface (BCI) is a newly developing rehabilitation technology for motor impairment. The last two runs of the pre-therapy screening phase and the first two runs of the post-therapy screening phase incorporated cued imaginary hand movements. Journal of NeuroEngineering and Rehabilitation Figure illustrates how synchronized patterns of action potentials may result in macroscopic oscillations that can be measured . The study aimed at investigating the maturation of cortical oscillations involved in the improvement of APAs efficiency. Mu desynchronization during observation of an action is believed to reflect mirroring system activation in humans. There was a significant correlation between RMT and mu ERD of the session in which MT was determined (r = 0.94, p < 0.05), whereas there was no significant correlation between mu ERD and AMT (r = 0.14) (Fig. Scalp or surface level EEG recordings are understood to read the dipolar or regional sources assumed to represent the synchronous activity of hundreds of thousands of underlying neighboring neurons. You may switch to Article in classic view. Circulation 135 e229e445. Benjamin E. J., Blaha M. J., Chiuve S. E., Cushman M., Das S. R., Deo R., et al. 7 139146. However, we did not assess the motor cortex excitability after tDCS. Changes in functional brain organization and behavioral correlations after rehabilitative therapy using a brain-computer interface. Unfortunately, retraining the processes of the descending motor system is not always an option as stroke often results in irreparable tissue damage or death to motor pathways and even their sensorimotor confederates. Power J. D., Cohen A. L., Nelson S. M., Wig G. S., Barnes K. A., Church J. Front Syst Neurosci. Highdensity EEG was used to assess the mu rhythm desynchronization in an action observation task where the infants observed a live model. Simulation of neural oscillations at 10 Hz.Upper panel shows spiking of individual neurons (with each dot representing an individual action potential within the population of neurons), and the lower panel the local field potential reflecting their summed activity. Electrodes pooled over the PSM areas are shown in red rectangles and yellow rectangles show electrodes pooled over the SMA. Evidence for changes in mu activity would fit with there being early-evoked motor responses to objects that are mediated by grip congruency. Utilizing a larger and more homogeneous subject cohort could allow for more generalizable conclusions in future research. The time-points at which neuroimaging data were collected are represented by,, BCI intervention block design. Fogassi L., Gallese V., Buccino G., Craighero L., Fadiga L., Rizzolatti G. (2001). Previous work indicates a functional distinction between lower (810 Hz) and upper (1012 Hz) mu rhythm activity, associated respectively, with widespread non-specific movement and focused specific movement activities (Pfurtscheller et al., 2000). At the motor cortical strip (generally, Brodmann areas 36), each brain hemisphere desynchronizes with imagined, attempted, and also preparation of movement. Summary of mean outcome measure scores for baseline, completion, and follow-up of the BCI training conditions. At a later time period (after 180 ms) Petit et al. In previous publications, the TDU (Kaczmarek, 2011) has been described and its use in a BCI paradigm detailed (Wilson et al., 2012). The units of the variance were those of the data squared: as the EEG data units were in micro Volts, the variance units were squared micro Volts. Figure 7, ,88 show topographical maps (topoplots) of grand averages for signed r-squared values at group level (n = 21) and topoplots of grand averaged coherence values at group level for Mu (812 Hz) rhythm and Beta (1826 Hz) band during imaginary movement trials, respectively. Proc Natl Acad Sci USA 1956, 42: 687-694. Behboodi A, Lee WA, Hinchberger VS, Damiano DL. Further, 16 electrodes were used in EEG signal data acquisition and EEG were recorded only during the intervention phase and at no other time during the study. 10.1016/j.cogbrainres.2005.08.016, Article The results are consistent with congruent hand grip generating a rapid and relatively automatic motor response to objects, especially when a familiar object is presented. Previous research has shown that the left hemisphere is dominant for the representation and planning of motor action (Haaland and Harrington, 1996; Rushworth et al., 2001). Noninvasive braincomputer interfaces (BCIs), which utilize ancillary adjuvant peripheral devices and electrical muscle stimulation, as well as invasive BCI approaches with electrodes implanted in the skull, have been introduced (Wolpaw et al., 1991; Leuthardt et al., 2004; Schalk et al., 2004, 2008; McFarland et al., 2006; Felton et al., 2007) as contemporary intervention and rehabilitation techniques following neural disease or trauma, such as stroke. All intervention sessions included in this analysis contained a similar distribution of these conditions across all participants. Brain-computer interface in stroke rehabilitation. In the top two rows of topoplots, a larger negative value (blue) denotes stronger desynchronization (rest vs. left or right hand actual movement); in the bottom row of topoplots a larger positive value (red) denotes desynchronization (left vs. right hand actual movements). 10.1016/S1388-2457(99)00141-8, Suffczynski P, Kalitzin S, Pfurtscheller G, Lopesda Silva FH: Computational model of thalamo-cortical networks: dynamical control of alpha rhythms in relation to focal attention. Acta Neurol Scand 2002, 105: 146-151. This interim analysis of the larger ongoing study seeks to elucidate the electrophysiological consequences and associations of BCI participation and the authors focus specifically on the behavioral (primary outcome) associations in another manuscript published in tandem with this effort (Remsik et al., 2018). (2009). Subjects from the greater study cohort were excluded from the presented analyses if they (1) failed to complete at least 9 of 15, two-hour BCI intervention sessions occurring at least twice each week, (2) failed to complete all four MRI and behavioral testing sessions occurring in the intervention phase (Figure 1). A significant increase in r-squared values [reflecting Mu rhythm (812 Hz) desynchronization as the result of attempted movements of the impaired hand] presented post-therapy compared to baseline. These results suggest that EEG-BCI-FES has the potential to induce neuroplastic change and aid recovery of UE paresis. Participants responded by pressing the keys on the keyboard with either their right or left hand index fingers (nine participants used their right had to respond yes, the other eight used their left hand). In the present work, event related spectral perturbations (ERSP) of the EEG -rhythm were analyzed, while manipulating two factors: Felton E. A., Wilson J. ** Post hoc LSD analysis showed a statistically significant difference (p < 0.01). Kuiken T. A., Schultz Feuser A. E., Barlow A. K. (2013). In this study, we studied whether tDCS application could modulate the cortical signal, such as mu ERD during right hand grasping images. The ARAT is a 57-point test designed to assess specific changes in upper limb function with sub-components for grasp, grip, pinch, and gross motor movement (Hsieh et al., 1998). Topoplots of grand averages for signed r-squared values at group level (n = 21) for imaginary movements. official website and that any information you provide is encrypted Activity for 1000 ms pre-stimulus was taken as the reference interval and reflected activities associated with fixation cross processing. The y-axis shows the mu ERD before the tDCS. Mu and Beta sensorimotor rhythms (SMRs) in human subjects are recorded exclusively over sensorimotor areas at frequencies of about 1020 Hz (Pfurtscheller et al., 1997; Birbaumer et al., 2006). Objective: Electrophysiological correlates of cognitive . This BCI system uses the same TDU stimulation parameters as were reported previously (Wilson et al., 2012). All data and time points analyzed and presented herein were recorded during the BCI intervention period only, for all participants. Muthukumaraswamy S. D., Johnson B. W., McNair N. A. Loss of motor function is a common deficit following stroke insult and often manifests as persistent upper extremity (UE) disability which can affect a survivor's ability to participate in activities of daily living. RT, event-related desynchronization (ERD) patterns of mu rhythm onset, and ERD amplitudes were selectively analyzed. For each data point, ERD/ERS were calculated in accordance with the standard formula: [(band-power-active-interval band-power-reference-interval)/band-power-reference-interval] 100. The EEG-BCI-FES device was driven by spectral power recordings from contralateral (to the hand active in the grasping task) EEG electrodes during cued attempted grasping movements of the hand which was designed to modulate the horizontal movement of a cursor (Schalk et al., 2008) in a computer display space as well as facilitate concurrent functional electrical stimulation of the participants impaired UE (should the target appear on the side corresponding to their stroke-impaired hand). Recent research suggests the use of braincomputer interface (BCI) devices might improve UE function in stroke survivors at various times since stroke. During this preliminary session, the EEG cap (Figure 3), FES device, and TDU device were faithfully administered as described previously (Wilson et al., 2012). Sanjay Kumar, M. J. Riddoch, and Glyn Humphreys. The NIHSS is composed of 11 items, each of which scores a specific ability between zero and four with higher scores indicating increased impairment (Ortiz and Sacco, 2008). The mechanism of ERD is considered to be a decrease in synchrony of the underlying neuronal population [2]. The trial length was 4 s and the resolution of Fourier Transforms was 1/4 = 0.25 Hz. The raw EEG data files were loaded into Fieldtrip (a MATLAB-based toolbox for advanced neurophysiological data analyses), and fully processed using tools incorporated in this toolbox (Oostenveld et al., 2011) and MATLAB environment2. Most notably, ERD observed in the mu frequency band (812 Hz) is typically taken as evidence of motor preparation (Pfurtscheller et al., 1997, 2000; Derambure et al., 1999; Pineda, 2005) and has been observed in relation to both object-directed grasp responses (Pfurtscheller et al., 1996; Muthukumaraswamy and Johnson, 2004) and precision grips (Muthukumaraswamy et al., 2004). The task was to decide as quickly as possible whether the target was a real object or a non-object. Federal government websites often end in .gov or .mil. The rest-activity rhythm of patients with CM (n=23) and non-headache controls (NH, n=23) was assessed by actigraphy for 15 days, and they completed the . already built in. Nitsche MA, Paulus W: Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Methods: Alpha (~10Hz) and beta (~20Hz) spectral components of the mu () rhythm, localized to sensorimotor regions, have been shown to index somatosensory and motor activity, respectively. Nitsche MA, Nitsche MS, Klein CC, Tergau F, Rothwell JC, Paulus W: Level of action of cathodal DC polarisation induced inhibition of the human motor cortex. Importantly, a much different level of evidence exists for CIMT and traditional therapies than experimental therapies such as tDCS and VR-based approaches. Error rates and median reaction times (RTs) for correct response trials were analysed with a 2 (object type) 2 (grip) repeated measure analysis of variance (RMANOVA). Most notably, objects assigned a correct grip showed enhanced and prolonged ERD over primary motor cortex scalp region and SMA scalp regions, when compared to the other conditions (objects assigned an incongruent grip or non-objects). 10.1016/S1388-2457(02)00412-1, Lopesda Silva FH: Neural mechanisms underlying brain waves: from neural membranes to networks. The functional significance of mu rhythms: translating seeing and hearing into doing. 2022 Apr 14;10:2100408. doi: 10.1109/JTEHM.2022.3167552. PMC legacy view 10.1016/0013-4694(93)90114-B, Article The change in r-squared values (Beta band) in the ipsilesional hemisphere motor site during impaired hand attempted movements, following the intervention, showed a significant correlation with the total number of cursor trials (i.e., amount of BCI practice) runs [r(20) = 0.393; p = 0.043] (Figure 9). Study design. EEG data were only collected during the intervention phase. AR was involved in subject recruitment, staff training, data collection, data processing, data analysis, interpreting data, and writing of the manuscript. Beta band desynchronization or attenuation during movement is considered an index of normal . ERS for non-objects started earlier than for objects and ERD related to congruently gripped objects lasted longer and had a greater amplitude in the lower (A) and the upper (B) mu frequency bands. The bar graph displays the significant difference in the group mean r-squared values. Contralesional brain-computer interface control of a powered exoskeleton for motor recovery in chronic stroke survivors. Pfurtscheller G., Neuper C., Krausz G. (2000). The error bars represent 1 standard error. As stated in Section Amount of Intervention: Number of Runs, the amount of BCI practice was positively correlated with Beta band ERD of the ipsilesional motor cortex. Greater power is needed to adequately generalize these results. Electromyogram (EMG) was simultaneously recorded from the first dorsal interosseous (FDI) with surface Ag/AgCl disc electrodes (1 cm in diameter) to confirm EMG activities during imagery tasks for avoiding unexpected muscle contraction. Yoon et al. Bethesda, MD 20894, Web Policies Yoon and Humphreys (2005) had participants verify a name to an object that was depicted with a hand offering a grip that was either congruent or incongruent with the action applied to use the object. The natural absence of a flexor digitorum superficialis tendon to the fifth digit in some individuals was not considered in this study design. (6) Coherence estimation was calculated between all pairs of channels (120 pairs from 16 available scalp channels) at every 1 Hz frequency bin of the mentioned interval. Background: A large body of evidence suggested that disruption of neural rhythms and synchronization of brain oscillations are correlated with a variety of cognitive and perceptual processes. 10.1016/S0167-8760(01)00177-5, Kuhlman WN: Functional topography of the human mu rhythm. Outcome measures of function and capacity were assessed at baseline, mid-therapy, and at completion of therapy while EEG was recorded only during intervention sessions. All subjects showed the mu ERD over the left cortex during motor imagery before tDCS. (2017) observed mu desynchronization in anticipation of tactile stimulation to one's own hand, which was not present when a partner or "nobody" received tactile . The Nine-Hole Peg Test (9-HPT) is a brief, standardized, quantitative test of UE function (Mathiowetz et al., 1985). This is to suggest that the minimal gains observed by most participants, in comparison to the significant gains obtained by some, and their absence in others, may be related to the encouragement of attempting previously ineffective motor behaviors. JS was involved in recruitment of study participants, study design, and intellectual content. Source reconstruction will be done once the sample size increases to sufficiently examine this aspect in a subset of stroke participants with homogeneity in lesion location. 10.1161/CIR.0000000000000485 Shen et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. ClinicalTrials.gov, identifier {"type":"clinical-trial","attrs":{"text":"NCT02098265","term_id":"NCT02098265"}}NCT02098265.
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