Objective: To investigate the long-term behavioral and neurophysiologic effects of combined time-locked repetitive transcranial magnetic stimulation (rTMS) and physical therapy (PT) intervention in chronic stroke patients with mild motor disabilities. Methods: Thirty patients were enrolled in a double-blind, randomized, single-center clinical trial. Patients received 10 daily sessions of 1 Hz rTMS over the intact motor cortex. In different groups, stimulation was either real (rTMS_R) or sham (rTMS_S) and was administered either immediately before or after PT. Outcome measures included dexterity, force, interhemispheric inhibition, and corticospinal excitability and were assessed for 3 months after the end of treatment. Results: Treatment induced cumulative rebalance of excitability in the 2 hemispheres and a reduction of interhemispheric inhibition in the rTMS_R groups. Use-dependent improvements were detected in all groups. Improvements in trained abilities were small and transitory in rTMS_S patients. Greater behavioral and neurophysiologic outcomes were found after rTMS_R, with the group receiving rTMS_R before PT (rTMS_R-PT) showing robust and stable improvements and the other group (PT-rTMS_R) showing a slight improvement decline over time. Conclusion: Our findings indicate that priming PT with inhibitory rTMS is optimal to boost use-dependent plasticity and rebalance motor excitability and suggest that time-locked rTMS is a valid and promising approach for chronic stroke patients with mild motor impairment. Classification of evidence: This interventional study provides Class I evidence that time-locked rTMS before or after physical therapy improves measures of dexterity and force in the affected limb in patients with chronic deficits more than 6 months poststroke. Neurology® 2012;78:256–264

The paper proposes a free dataset, available at the following link1, named KIMORE, regarding different rehabilitation exercises collected by a RGB-D sensor. Three data inputs including RGB, Depth videos and skeleton joint positions were recorded during five physical exercises, specific for low back pain and accurately selected by physicians. For each exercise, the dataset also provides a set of features, specifically defined by the physicians, and relevant to describe its scope. These features, validated with respect to a stereophotogrammetric system, can be analyzed to compute a score for the subject’s performance. The dataset also contains an evaluation of the same performance provided by the clinicians, through a clinical questionnaire. The impact of KIMORE has been analyzed by comparing the output obtained by an example of rule and template-based approaches and the clinical score. The dataset presented is intended to be used as a benchmark for human movement assessment in a rehabilitation scenario in order to test the effectiveness and the reliability of different computational approaches. Unlike other existing datasets, the KIMORE merges a large heterogeneous population of 78 subjects, divided into 2 groups with 44 healthy subjects and 34 with motor dysfunctions. It provides the most clinically-relevant features and the clinical score for each exercise.

Objective . A randomized controlled observer-blind trial was designed to evaluate the effectiveness of action observation as an add-on treatment to the standard rehabilitation of upper-limb function, early after stroke. Methods . Stroke survivors (N = 102) were consecutively recruited from 13 centers 30 days (±7) after a first-ever stroke and randomly assigned to the experimental (EG) or control group (CG). EG participants watched video footage of daily routine tasks (actions) carried out with the upper limb in order to prepare to imitate the presented action. At the end of each sequence, a therapist prompted the patient to perform the same movement for 2 minutes, providing help when needed. Static images without animals or human beings were shown to the CG. At the end of each sequence, the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG. Results for the Fugl-Meyer test, Frenchay Arm test, Box and Block test (BBT), Modified Ashworth Scale, and Functional Independence Measure Motor items were recorded before treatment (T0), after 4 weeks of treatment (T1), and at the follow-up visit 4 to 5 months after the conclusion of treatment (T2). Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs. A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT, showing significant T0–T1 and T0–T2 differences in favor of EG. Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation, along with a role for the mirror neuron system in poststroke recovery.