Annals of the New York Academy of Sciences

With transcranial direct-current stimulations (tDCS) rising popularity both in motor learning research and as a commercial product, it is becoming increasingly important that the quality of evidence on its effectiveness be evaluated. Special attention should be paid to meta-analyses, as they usually have a large impact on research and clinical practice. The aim of this study was to evaluate the methodological quality of meta-analyses estimating the effect of tDCS on motor learning with respect to reproducibility as the main focus, and reporting quality and publication bias control as secondary aspects. The three meta-analyses we reviewed largely adhered to PRISMA reporting guidelines and reported the primary effect sizes and sampling variances / confidence intervals they calculated, enabling successful reproductions of pooled effect size estimates. However, akin to previous meta-research reviews with similar aims, we found the methods and results sections of the meta-analyses to be severely underreported, which compromises the ability to judge the soundness of the methodological procedure adopted as well as its reproducibility. While publication bias detection methods were applied, the approaches chosen do not allow for well informed decisions about the presence or extent of publication bias. These results reemphasise the need to transparently report methods in meta-analyses and to meticulously evaluate their quality before and after publication.

INTRODUCTIONTools to document communicative ability in people living with primary progressive aphasia (PwPPA) are limited. This work describes the development of a strengths-based and ecologically-valid instrument--the Progressive Aphasia Communication Toolkit (PACT). METHODSThis work consisted of five experiments: two to develop (Experiments 1 and 2) and three to pilot (Experiments 3-5) a novel instrument for PPA. Ninety-five individuals worldwide contributed to this work: 80 researchers and clinicians, 9 PwPPA, and 6 care partners. RESULTSExperiments 1-2 culminated in an instrument comprising four scales that capture quantitative and qualitative feedback. Experiments 3-5 resulted in structural refinement and digitization of the tool, revealed PwPPA and care partner preference for the PACT over traditional neuropsychological evaluation, and demonstrated strong inter-rater agreement for general measurability (91%) and strength ratings (85%). DISCUSSIONCurrent findings indicate that the PACT provides a holistic profile of communication strengths for PwPPA and can guide clinicians in developing functional therapeutic targets.

PurposeAuditory and somatosensory systems jointly support vocal motor control, yet their relative and combined contributions in primary muscle tension dysphonia (pMTD) remain poorly understood. This study examined how auditory and somatosensory feedback influence vocal motor control and adaptation in individuals with and without pMTD. MethodFifty-one participants (pMTD: n = 10; controls: n = 41) completed a 200-trial altered auditory feedback (AAF) paradigm involving sustained vowel productions with fundamental frequency (f) downward shifts at -100 cents. The task was repeated with nebulized lidocaine to transiently attenuate laryngeal somatosensory input. Data were analyzed to extract the magnitude and direction of vocal adjustments across baseline, ramp, hold, and washout phases. ResultsVocally healthy controls demonstrated robust adaptive vocal response to f feedback alterations followed by an adaptive after-effect during the washout phase, particularly when somatosensation was intact. In contrast, when somatosensation was intact, individuals with pMTD displayed exaggerated overshooting vocal responses in f, lacked typical after-effect adaptation, and showed greater variability overall. Notably, somatosensory disruption stabilized adaptation in pMTD with nebulized lidocaine. ConclusionThese findings demonstrate that pMTD is characterized by maladaptive reliance on somatosensory input that interferes with normal auditory-motor integration. While vocally healthy speakers use somatosensory cues to stabilize vocal control, in pMTD these cues may act as a source of instability. The results underscore the need for therapeutic approaches targeting sensory-motor integration, including individualized interventions that recalibrate the balance between auditory and somatosensory feedback. This study reframes pMTD as a multisensory integration disorder and opens new directions for mechanism-driven voice therapy.

ObjectivesThis study aimed to compare the effects of short versus intensive bimanual training on spatiotemporal features of bimanual coordination in children with unilateral cerebral palsy (UCP). MethodsIn a prospective, repeated-measures design, 28 children with UCP completed two training regimens: a short dose (75 repetitions of speed stacking; [~]1-1.5 hours) and an intensive dose (30 hours of Hand arm bimanual intensive training). Bimanual learning was indexed by average time to complete nine stacking trials. Spatiotemporal kinematics were evaluated using three-dimensional motion analysis. For the bimanual coordination task, (3-2-1 stacking) outcomes included normalized movement overlap, total task duration, and participation time. For a symmetric bimanual task (simultaneous two-cup transfer), task synchronization and completion time were analyzed. Peak tangential velocity and hand trajectory were assessed across both tasks. General linear models with repeated measures were used to analyze the effects of training dose and extremity. ResultsThere was a significant main effect of training dose on movement time (p < 0.001), with both doses improving bimanual learning. The intensive dose yielded significantly greater gains in normalized movement overlap, total task duration, hand trajectory, and participation time (all p = 0.001) during the bimanual coordination task. A dose-by-extremity interaction was identified for peak tangential velocity (p = 0.03), demonstrating greater velocity gains in the more affected limb. In the symmetric task, a main effect of dose was found only for hand trajectory (p < 0.03). ConclusionsBoth short and intensive bimanual training enhanced bimanual learning and coordination in children with UCP. While intensive training yielded greater improvements, even brief, ecologically valid tasks produced measurable gains, highlighting the importance of training intensity and task specificity in pediatric neurorehabilitation.

ObjectiveThe first aim was to assess the immediate and long-term effects of prism adaptation (PA) on spatial neglect (SN) via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential predictive factors of PA efficacy. MethodsWe searched 4 databases up to March 2025 for RCTs comparing PA or PA+conventional vs. shamPA or shamPA+conventional or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego Scale (CBS) and Behavioral Inattention Test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95%CI. ResultsOnly 10 RCTs (356 participants) could be included, 8 of them reporting CBS data and 6 for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group and control group (all studies with prism shift [&ge;]10{degrees}, WMD= -2.13, 95%CI: [-3.93, -0.33], P<0.05), while non-significance for BIT-C. Long-term benefit was not significant for CBS, while significant for BIT-C when the prism shift was [&ge;]10{degrees} (WMD= 12.37, 95%CI: [0.53, 24.21], P<0.05). Linear regressions showed non-significant predictive factors among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials x prism shift) subgroup (WMD= -2.73, 95%CI: [-5.01, -0.44], P<0.05), whereas subgroup with smaller total exposure showed non-significance. ConclusionEven with stringent inclusion criteria, robust effects of PA on SN were observed in the short-term CBS (all studies with prism shift [&ge;]10{degrees}), mainly derived from studies with total exposure [&ge;]11250{degrees}{middle dot}trials. A significant improvement for long-term BIT-C was observed when the prism shift was [&ge;]10{degrees} (n=2, with 4000{degrees}{middle dot}trials and 21600{degrees}{middle dot}trials). The total quantity of prism exposure ({degrees}{middle dot}trials) may be a useful predictive efficacy factor of efficacy.

Background and aimsEthical considerations play a crucial role in physiotherapy, influencing patient care, professional conduct, and clinical decision-making. Despite its significance, there is a limited comprehensive understanding of how ethical principles are applied in physiotherapy practice. The evolving nature of the field, alongside advancements in treatment approaches, presents new ethical challenges that require systematic investigation. This scoping review aims to map the existing literature on ethical issues within physiotherapy, identify research methodologies, and highlight knowledge gaps. MethodThis review will follow the methodological framework proposed by the Joanna Briggs Institute (JBI) for scoping reviews and will be reported following the PRISMA for Scoping Reviews guidelines. A comprehensive search will be conducted on PubMed, Medline, Embase, CINAHL, PsychInfo, Cochrane Central, and Pedro. The gray literature will be consulted. Studies involving physiotherapists and those addressing ethical issues in physiotherapy practice will be included. Data extraction will be based on a standardized form, and a narrative synthesis will categorize the ethical issues and principles. DiscussionThe review will provide a broad overview of ethical issues and principles in physiotherapy. It will inform future research priorities, guide ethical training for practitioners, and support the development of policies and guidelines to improve ethical shared decision-making in physiotherapy practice.

PurposeHuman anatomy remains foundational to clinical practice, yet reduced instructional hours raise concerns about graduate competence and preparedness for patient care. Although trainees often report confidence, supervisors may perceive deficiencies, creating a gap between self-assessment and external evaluation. This study examined stakeholder perspectives on anatomical competence within physical therapy education to identify areas of discordance in perceived capability. MethodsA cross-sectional web-based survey collected responses from 165 stakeholders associated with an entry-level Doctor of Physical Therapy program featuring a 16-week dissection curriculum. Participants rated four domains of anatomical competence using a 5-point ordinal scale. Group differences were analyzed with the Kruskal-Wallis test appropriate for ordinal data. This methodology ensured robust assessment of stakeholder perceptions and comparative analysis. ResultsMedian ratings of preparedness and capability were 4 of 5 (quite prepared). Significant discordance emerged in three domains: recent graduates rated their foundational knowledge and ability to explain complex concepts to lay audiences higher than faculty or clinical instructors, whereas faculty expressed lower confidence in graduates ability to explain patient symptoms using anatomical principles. No significant differences were observed in the ability to describe structures by location, suggesting shared perceptions of basic anatomical understanding despite variation in applied reasoning. ConclusionsStakeholders generally viewed graduates as well prepared, yet disagreement persisted regarding clinical application of anatomical knowledge. Faculty skepticism about symptom explanation indicates that mastery of anatomy alone does not guarantee clinical reasoning. Curricular strategies emphasizing vertical integration and explicit connections between anatomical science and patient-centered reasoning may help bridge perception gaps and enhance professional competence.

PurposeStimulability testing is a wide-spread and highly valued behavioral assessment tool for voice-specialized speech-language pathologists (SLPs). However, there is currently no research examining how voice SLPs use stimulability testing to inform their clinical reasoning process and decisions. The purpose of this qualitative study was to examine the clinical reasoning underlying stimulability testing for voice-specialized SLPs across the experience spectrum. MethodsSemi-structured interviews were conducted with eight voice-specialized SLPs (four early-career, four late-career) regarding stimulability testing, including how they used stimulability testing to form clinical conclusions such as candidacy and prognosis for behavioral therapy. Interviews were transcribed and analyzed using the interpretative phenomenological analysis (IPA) framework (Smith & Osborn, 2003). ResultsFive themes emerged from the IPA analyses: Perceiving and monitoring patient responses; Developing and trusting clinical skills; Decision-making strategies; Drawing clinical conclusions; and Fostering a purposeful therapeutic relationship. Within the Drawing clinical conclusions theme, clinicians differed on the utility of stimulability testing as a tool for determining patient candidacy and prognosis for behavioral therapy. ConclusionSLPs rely on both analytical and intuitive methods of clinical reasoning during stimulability testing. However, the lack of research tying stimulability testing to clinical outcomes has led to an overreliance on intuitive reasoning when SLPs attempt to draw clinical conclusions. Further empiric support for the clinical functions of stimulability testing is needed to support the clinical reasoning process surrounding this assessment tool.

MotivationGlaucoma is a progressive visual pathway disorder leading to visual field loss, which can be linked to disruptions in visuo-motor function and an increase in fall risk. Motor-cognitive training has been shown to affect visuo-motor functional connectivity (FC) in healthy controls (HC) and could therefore be a viable strategy for the management of glaucoma patients (GL). MethodsUsing 3T resting state functional-MRI (rs-fMRI), we studied the effect of a multimodal intervention (MMI [resistance + motor-cognitive dual-task training]) and unimodal intervention (UMI [resistance training only]) on rs-FC in 20 HC and 12 GL, randomly assigned to MMI (7GL, 9HC) and UMI (5GL, 11HC). Rs-fMRI was acquired pre- and post the 12-week intervention. Whole-brain FC were estimated with bilateral seeds in the visuo-motor pathway and paired longitudinal comparisons were performed to test effects of the interventions. ResultsLongitudinal effects of UMI were only observed in HC and were limited to an increase in FC between the cerebellum, midcingulate gyrus, and the frontal eye fields (pFWE<0.05). Interestingly, MMI had a widespread effect including an increase in FC within the visual pathway, between auditory and visual cortices, and with the motor cortex after MMI (pFWE<0.05) in both HC and GL. In addition, an increased FC between the dorsolateral prefrontal cortex, inferior frontal gyrus, sensorimotor cortex, and the inferior temporal gyrus (pFWE<0.05) was observed in GL after MMI. An increase in FC was also found between the cerebellum and the midcingulate gyrus (pFWE<0.05) in GL that underwent MMI. ConclusionOverall, our findings indicate a widespread effect of MMI in both HC and GL on rs-FC, highlighting cortical plasticity in GL. These results motivate further research on the effects of motor-cognitive interventions for visual pathway disorders like glaucoma.

Dyad practice of complex motor skills, characterized by two learners alternating between physical and observational practice, can yield better motor outcomes and reduce practice time compared to physical practice alone. It is unknown if the superior effects of dyad practice on motor learning extend to proprioceptive learning. Forty-two healthy participants (18-35 years) were randomized into three groups (n=14 each): Dyad practice, physical practice with rest (PP-rest), and physical practice without rest (PP-no rest). Participants practiced a 2 degree-of-freedom gamified wrist movement task for 20 minutes using a custom-made wrist robotic device. Wrist position sense acuity was assessed before (baseline) and 24 hours after the end of training (retention), using the Just-noticeable-difference (JND) threshold and Uncertainty. Only the PP-no rest group exhibited significantly lower JND thresholds at retention compared to baseline (t(13)=2.44; p= 0.03, Hedges g=0.70). There were no differences in position sense Uncertainty within or between groups. Dyad practice may yield superior gains in motor performance, but this did not translate into comparable gains in proprioceptive acuity. A possible explanation for these findings is that the recruitment of explicit motor learning mechanisms during dyad motor skill practice does not enhance the implicit learning mechanisms underlying proprioceptive learning. HighlightsO_LIDyad practice (DP) may yield superior motor gains compared to physical practice C_LIO_LIDP does not yield superior proprioceptive gains compared to physical practice C_LIO_LIIntensive physical practice yields the largest gains in position sense acuity C_LI

AimTo determine the mechanistic relationship between segmental trunk control in the neutral vertical posture (NVP), assessed using the Segmental Assessment of Trunk Control (SATCo), and the Gross Motor Function Classification System (GMFCS); and hence to identify the means to enhance function in children with cerebral palsy (CP). MethodThis cross-sectional study included 101 children with CP (34 female, 10y(3y8m), 1.32(0.27)m, 33.4(18.4)kg) classified across GMFCS Levels I-V and tested with SATCo. Association and variation between GMFCS Levels and SATCo results were examined. ResultsSATCo results differed significantly (p<.05) between GMFCS Levels in static, active and reactive tests of trunk control. As neuro-ability increases through GMFCS Levels V-I, ability to control the head and trunk in NVP increases ({rho}(99)=-0.61 to -1,p<.0001) and variation in head and trunk control increases ({rho}(3)=-0.9 to -1,p<.05). InterpretationSATCo provides mechanistic insights supporting its use following GMFCS. In severe CP, NVP control is minimal across all children. In mild CP, large variation in results shows that SATCo discriminates between the use of full trunk control from compensatory strategies to achieve function. For each GMFCS Level, SATCo identifies the training required to improve trunk control in NVP, thus improving functional performance and reducing long-term risk of deformity. What this paper addsO_LISATCo results are related to GMFCS Levels, and complements GMFCS C_LIO_LISATCo provides the mechanistic explanation for what is observed in GMFCS C_LIO_LISATCo-GMFCS reveals if function is attained with trunk control or compensatory strategies C_LIO_LICompensatory strategies often used in mild CP are not captured by GMFCS C_LIO_LISATCo identifies the training required to improve function and reduce deformity risk C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=115 SRC="FIGDIR/small/26344472v2_ufig1.gif" ALT="Figure 1"> View larger version (19K): org.highwire.dtl.DTLVardef@3ba4f1org.highwire.dtl.DTLVardef@1c9ce70org.highwire.dtl.DTLVardef@101d01org.highwire.dtl.DTLVardef@1e04861_HPS_FORMAT_FIGEXP M_FIG C_FIG O_LIExample above: GMFCS Level I child leaning backwards when tested for lower thoracic NVP trunk control. Same child showing compensatory lordotic lumbar posture while standing. C_LIO_LISATCo can be used in combination with GMFCS to identify specific training targets to improve postural control, enhance function, and reduce deformity risk. C_LI

AimTo investigate the relationship between somatosensory deficits, specifically ankle and hip joint position sense, two-point discrimination, and vibration on the (1) responses to visual perturbations during walking and (2) response improvements to visual perturbations while receiving a sensory-centric treatment, i.e., stochastic resonance (SR) stimulation, in individuals with and without cerebral palsy (CP). MethodsTwenty-eight individuals (14 CP, 14 age-and sex-matched controls) walked in a virtual reality cave while receiving visual perturbations. We applied SR to the ankle and hip joints. Data analysis consisted of bivariate correlations, and multiple regression analysis (MRA) using all four sensory tests as predictors with the responses to visual perturbation and the improvements in the responses when SR is applied as outcomes. ResultsWe found significant and strong correlations between performance on sensory tests and the responses to visual perturbations, and improvements in the responses with SR. Only one predictor could be entered into the MRA, indicating that performance on any of the sensory tests could predict the responses to visual perturbation and the improvements with SR. InterpretationIndividuals with sensory deficits are more responsive to sensory-centric interventions. This study is an initial step in identifying potential "responders" to sensory therapies in individuals with CP.

Motor imagery (MI)-based neurofeedback (NFB) has recently been shown to improve MI ability using visual, auditory, vibrotactile, and proprioceptive modalities; however, no study has compared all four of these sensory modalities to each other and to a control group. This randomized controlled trial aimed to examine the effects of MI-based NFB on MI ability (the ability to improve ones motor abilities through visualizing movements) using visual, auditory, vibrotactile, and proprioceptive modalities. Fifty healthy young participants were recruited for this study and were randomly assigned to the control group or an NFB group using either visual, auditory, vibrotactile, or proprioceptive sensory feedback. All participants completed a pre-training evaluation of 20 trials without NFB. Next, 60 trials of the MI task (imagining themselves performing maximal dorsiflexion of the wrist joint) were performed during the training phase. After training, all groups were again assessed without NFB for 20 trials. For each NFB group, EEG was measured during the MI task, and event-related desynchronization (ERD) in motor-related areas was fed back to the participants in real time. The pre- and post-training results of ERD and subjective MI vividness were compared for each group; the results showed that ERD significantly increased after training in all four groups that performed NFB (p < 0.05) and that MI vividness increased significantly after training in all five groups (p < 0.05). The present study demonstrated that MI-based NFB using visual, auditory, vibrotactile, and proprioceptive modalities improved MI ability.

Individuals with Homonymous Visual Field Defects (HVFDs) after brain injury often experience difficulty in reading. This can be debilitating, as reading is an important aspect of daily life. The current study aims to explore the potential outcomes of two reading trainings for individuals with HVFDs. One training, the Vistra reading training, aims at compensating for the HVFD by practicing adjusted reading eye movements. The second training is the Rotated Reading training, which aims to utilize the intact visual field by practicing to read rotated text in a personalized angle. Next to assessing the potential outcomes of the Vistra and Rotated Reading trainings on a group and individual level, this study aims to investigate patient experiences with the trainings. Using a Partially Randomized Patient Preferred Controlled Trial, participants were assigned to one of three groups: Vistra, Rotated Reading or a waiting list control group. There were 5 participants included in both the Vistra and Rotated Reading groups, and 10 in the control group. Assessments were conducted before(T1), after(T2) and 3 months after(T3) training or the waiting period, including reading speed, self-reported reading efficacy, attitude, skills, and objects, and quality of life. Results showed significant group-level improvements following Vistra training on reading speed, self-reported reading skills and reading objects. Furthermore, within some Vistra participants, significant individual changes were observed on reading speed, self-reported reading efficacy, reading objects and quality of life. No significant group effects were found for Rotated Reading training, but some individuals demonstrated significant individual changes on self-reported reading efficacy and reading skills. Qualitative analysis identified five key themes of reading training outcome: reading objects, reading skills, reading enjoyment, reading certainty and non-reading related outcomes. Participants reported adopting specific reading strategies and emphasized perceived improvement as a key motivator for continued use. Feedback highlighted the wish for personalized training approaches.

BackgroundAesthetic education is pivotal in shaping a comprehensive and harmonious humanity. However, the transition from semantic comprehension to aesthetic appreciation remains poorly understood. This study, informed by transactional theory, sought to elucidate the cognitive mechanisms of aesthetic reading by examining its neural dynamics through functional Near-Infrared Spectroscopy. MethodsParticipants were tasked with reading Tang poetry aesthetically, with fNIRS monitoring brain activity in frontal and temporal regions. ResultsCompared to an efferent reading task, the aesthetic reading task revealed a distinct three-stage neural dynamic pattern. Initially, aesthetic reading showed similar HbO activation in all regions, likely indicating the semantic processing phase. This was followed by a divergence, with a decrease in HbO over the left primary somatosensory cortex and the left superior, inferior, and middle temporal gyri, suggesting inhibition of semantic processing. Finally, a resurgence of activity in these areas was observed, along with an increase in HbO over the left dorsolateral prefrontal cortex, which could be associated with memory, imagination, and empathy. This reactivation correlated with participants self-reported aesthetic appreciation scores. ContributionThe findings reveal the temporal and spatial dynamics of brain activity during aesthetic reading, enhancing our comprehension of underlying cognitive processes.

BackgroundThoracic spine mobilization (TSM) has been proposed to influence autonomic nervous system (ANS) activity, yet evidence remains inconsistent and feasibility of standardised protocols is unclear. This study aimed to evaluate whether a randomized TSM protocol can be implemented successfully in healthy participants and to provide preliminary estimates of its effects on heart rate variability (HRV) and heart rate (HR). MethodsA randomized feasibility trial was conducted with healthy young adults receiving six manual therapy sessions consisting of rotational mobilizations above Th5 over 14 days. Feasibility outcomes included adherence, absence of unexpected adverse events (UAE), and practicality of autonomic data acquisition. Physiological outcomes comprised HRV parameters, high-frequency (HF), low-frequency/high-frequency ratio (LF/HF) and HR, analyzed using autoregressive (AR) and fast Fourier transform (FFT) methods. ResultsProcedural safety and methodological integrity were confirmed (no UAE; complete datasets), but feasibility was only partially achieved due to adherence shortfalls, higher attrition, and device-related delays. Physiologically, large effect sizes were observed in the intervention group: at evening assessment, HF_AR showed ES = 0.80 (p = .008); at morning assessment, HF_FFT ES = 0.72 (p = .016), HF_AR ES = 0.78 (p = .010), and LF/HF_AR ES = 0.70 (p = .021). HR remained unchanged. These findings suggest repeated TSM may modulate HRV, primarily through HF-related changes associated with vagal activity, while LF/HF interpretation remains controversial. ConclusionA randomized TSM protocol is safe and methodologically viable with logistical refinements. Preliminary evidence indicates potential vagal modulation, warranting larger trials with respiratory control, ECG-based HRV, multimodal ANS measures, and clinical populations to confirm efficacy and translational relevance.

Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinsons disease (PwPD), the size and duration of the effects of STN-DBS on motor axial (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait - FOG) are still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. festination, hesitation, axial motor dysfunctions, and FOG) in PwPD who are non-surgically treated. Despite the potential for positive adjuvant effects of PT following STN-DBS surgery, there is a paucity of science available on the topic. In such a scenario, gathering the opinion and expertise of leading investigators worldwide was pursued to study motor rehabilitation in PwPD following STN-DBS. After summarizing the few available findings through a systematic review, we identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review along with a Delphi method. Thirty-nine questions were submitted to the panel - half related to general considerations on PT following STN-DBS, half related to PT treatments. Despite the low-to-moderate quality, the few available rehabilitative studies suggested that PT could improve dynamic and static balance, gait performance and posture. Similarly, panellists strongly agreed that PT might help in improving motor symptoms and quality of life, and it may be possibly prescribed to maximize the effects of the stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed on prescribing of conventional PT, but not massage or manual therapy. Our results will inform the rehabilitation and the DBS community to engage, publish and deepen this area of research. Such efforts may spark guidelines for PT following STN-DBS. GRAPHICAL ABSTRACT O_FIG O_LINKSMALLFIG WIDTH=179 HEIGHT=200 SRC="FIGDIR/small/24314037v1_ufig1.gif" ALT="Figure 1"> View larger version (35K): org.highwire.dtl.DTLVardef@1c05553org.highwire.dtl.DTLVardef@21d4a2org.highwire.dtl.DTLVardef@10f1759org.highwire.dtl.DTLVardef@1c5dcce_HPS_FORMAT_FIGEXP M_FIG C_FIG

PurposeVisual function testing in retinal prosthesis users relies on repetitive psychophysical tasks that are cognitively demanding and fatiguing. Gamification may increase engagement, but its effects on perceptual performance in implanted users remain unclear. MethodsThree Argus II users completed circle localization and motion direction discrimination in clinical and gamified versions. Visual stimuli, trial structure, and response requirements were matched within each participant; gamified versions added scoring, background music, and affectively framed end-of-trial auditory feedback. Difficulty and response format were calibrated to individual abilities (8AFC for two participants; 4AFC restricted to cardinal directions for one participant). ResultsGamification improved accuracy and reduced angular error in localization but did not improve motion discrimination. Effects were task-dependent and varied across participants, with reduced precision in the gamified motion task for one user. Participants preferred gamified localization and reported higher enjoyment and sustained attention; responses to gamified motion were mixed. ConclusionsGamification can influence measured performance and user experience in prosthetic vision testing, but benefits are not universal and depend on task demands and cognitive load, indicating that engagement can affect outcomes in tests often treated as objective. Translational relevancePersonalized, engagement-aware gamified tools with adaptive difficulty may improve the usability and scalability of prosthetic vision assessment and rehabilitation, including at-home training.

AimWe investigated the heterogeneity of treatment effects in transcranial direct current stimulation (tDCS) with mindfulness-based meditation (MBM) and within each individual study group (tDCS alone, MBM alone, and sham) among individuals with symptomatic knee osteoarthritis. We also explored participant characteristics underlying this heterogeneity. MethodsThis secondary analysis drew on a double-blind, randomized, sham-controlled, phase II, parallel-group trial in which 200 participants were assigned to one of four groups: (1) active tDCS + active MBM, (2) active tDCS + sham MBM, (3) sham tDCS + active MBM, or (4) sham tDCS + sham MBM. Participants received ten 20-minute tDCS sessions (active or sham) administered concurrently with MBM (active or sham). Latent class growth analysis was used to identify subgroups with distinct treatment response trajectories (responders vs. non-responders) based on changes in clinical pain (Numeric Rating Scale) from baseline to post-intervention. Generalized linear models were then applied to determine baseline factors associated with participants response classification, including demographic, clinical, and psychological characteristics; quantitative sensory testing battery; and pain-related cortical hemodynamic activity measured using functional near-infrared spectroscopy (fNIRS) in response to punctate and thermal stimuli. ResultsResponders in the active tDCS + active MBM and active tDCS + sham MBM groups demonstrated greater improvements in clinical pain from baseline to post-intervention than non-responders (p < 0.001). In the active tDCS + active MBM group, greater cortical activation in the fNIRS channel S06-D06 of the left somatosensory cortex in response to punctate stimuli, identifying as white, and lower conditioned pain modulation (reflecting less efficient endogenous pain modulation), were significantly associated with being responders (p < 0.05). In the active tDCS + sham MBM group, younger age and lower heat pain tolerance at the knee were significantly associated with being responders (p < 0.05). No clear response patterns were observed in the remaining groups. ConclusionFactors underlying heterogeneity of treatment effects, including somatosensory cortical activation and pain modulatory profiles, may provide preliminary insights to inform the development of personalized neuromodulation (stimulation) protocols.

Brain imaging studies have demonstrated that adults with spinal cord injury (SCI) exhibit deficits in body and interoceptive awareness. However, there is limited research on the degree and impact of these deficits. Few clinical trials have examined interventions to improve body and interoceptive awareness in this population. We compared scores on the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2) and the Revised Body Awareness Rating Questionnaire (BARQ-R) between adults with SCI and uninjured adults. We also assessed changes in body and interoceptive awareness in adults with SCI following one of two body awareness interventions, i.e., Qigong and Cognitive Multisensory Rehabilitation (CMR). Adults with SCI reported worse interoceptive awareness than uninjured adults on the MAIA-2 dimensions "Not-distracting" [Median(IQR), SCI vs healthy=1.33 (1.17) vs 2.30 (1.5); p<.0001] and "Trust" [3.50 (1) vs 3.70 (1.3); p=.02]. Conversely, they scored better on "Noticing" [3.50 (1.38) vs 3.00 (1.50); p=.035], "Attention Regulation" [3.50 (1) vs 2.70 (1.3); p<.0001], "Self-regulation" (3.75 (1) vs 3.00 (1.5); p<.0001], and "Body Listening" [3.75 (1) vs 2.30 (1.70); p<.0001]. Adults with SCI displayed worse body awareness, indicated by higher BARQ-R scores [18 (6.50) vs 15 (7); p<.0001]. Post-intervention results revealed improvements on the MAIA-2 dimension "Not-Worrying" [pre: 3.00 (0.80) vs post: 3.40 (1.40); p=.03] and the BARQ-R [pre: 18 (7) vs post: 16 (7); p=0.0004]. Given the demonstrated deficit in body and interoceptive awareness and the potential for improvement with interventions, our results encourage further exploration on how improving body and interoceptive awareness can impact quality of daily life.