Reconstructing time-domain data from discontinuous Percept™ PC and RC output using external data acquisition and linear filtering.

Background: The Medtronic Percept™ PC and RC are deep brain stimulation (DBS) systems with recording capability. However, when the stimulation frequency is changed, the recordings were segmented, introducing interruptions that shift each segment in the time domain.

New Method: Ex-vivo, stimulation frequency was changed while local field potential was being recorded in both leads.

Forced-rate aerobic cycling improves locomotor function and gait biomechanics in individuals with chronic stroke: A randomized controlled trial.

Objective: While cycling and walking are different motor tasks, both require the rapid reciprocal activation and relaxation of lower extremity muscles in a synergistic manner, promoting coordination patterns similar to walking. The aim of this secondary analysis was to examine the effects of forced-rate cycling on gait biomechanics post-stroke.

Design: A randomized controlled trial was conducted investigating the neuroplastic effects of forced-rate cycling on upper extremity motor recovery in individuals (n = 60) post-stroke.

Bradykinesia and Its Progression Are Related to Interhemispheric Beta Coherence.

Objective: Bradykinesia is the major cardinal motor sign of Parkinson disease (PD), but its neural underpinnings are unclear. The goal of this study was to examine whether changes in bradykinesia following long-term subthalamic nucleus (STN) deep brain stimulation (DBS) are linked to local STN beta (13-30 Hz) dynamics or a wider bilateral network dysfunction.

Methods: Twenty-one individuals with PD implanted with sensing neurostimulators (Activa® PC + S, Medtronic, PLC) in the STN participated in a longitudinal 'washout' therapy study every three to 6 months for an average of 3 years.

An 8-week aerobic cycling intervention elicits improved gait velocity and biomechanics in persons with Parkinson's disease.

Background: It is unknown if improvements in gait velocity following an aerobic cycling intervention are accompanied by improved gait biomechanics in individuals with Parkinson's disease (PD) or if gait abnormalities are exaggerated in response to increased velocity. Research question Can an 8-week aerobic cycling intervention elicit improvements in locomotor function in individuals with mild to moderate PD?

Methods: A secondary analysis of data from a randomized clinical trial was conducted in individuals with mild to moderate idiopathic PD (N = 28). Participants were randomized to an aerobic cycling intervention (PD N = 14) consisting of 24 sessions at a targeted aerobic intensity of 60-80% of heart rate reserve or to a no intervention control group (PD, N = 14).

Components of a successful community-based exercise program for individuals with Parkinson's disease: Results from a participant survey.

Objectives: The aim of the project was to examine the personal beliefs, motivators, and barriers in people with Parkinson's disease (PwPD) relating to their participation in a year-round community-based cycling program, Pedaling for Parkinson's (PFP).

Design: Cross-sectional survey from a 12-month pragmatic study.

Setting: Five community-based PFP sites.

Lack of progression of beta dynamics after long-term subthalamic neurostimulation.

Objective: To investigate the progression of neural and motor features of Parkinson's disease in a longitudinal study, after washout of medication and bilateral subthalamic nucleus deep brain stimulation (STN DBS).

Methods: Participants with clinically established Parkinson's disease underwent bilateral implantation of DBS leads (18 participants, 13 male) within the STN using standard functional frameless stereotactic technique and multi-pass microelectrode recording. Both DBS leads were connected to an implanted investigative sensing neurostimulator (Activa™ PC + S, Medtronic, PLC).

High intensity aerobic exercise improves bimanual coordination of grasping forces in Parkinson's disease.

Introduction: Parkinson's disease (PD) disrupts the control and coordination of grasping forces, likely due to a disruption in basal ganglia circuitry and diminished activity within the supplementary motor area (SMA). High intensity aerobic exercise has been shown to enhance connectivity between basal ganglia nuclei and cortical areas, including the SMA. The aim of this project was to determine the effects of high intensity lower extremity exercise on motor control patterns underlying a manual dexterity task.

Errors in cognitive performance trigger postural instability in Parkinson's disease.

Background: Globally, postural stability and cognitive performance are intimately linked in Parkinson's disease (PD). However, a fundamental gap exists in understanding the precise relationship between a disruption in executive function and its impact on postural stability.

Objective: This project aimed to determine the precise effects of cognitive errors on postural stability under dual-task conditions in participants with PD and controls.

Use of a Smartphone to Gather Parkinson's Disease Neurological Vital Signs during the COVID-19 Pandemic.

Introduction: To overcome travel restrictions during the COVID-19 pandemic, consumer-based technology was rapidly deployed to the smartphones of individuals with Parkinson's disease (PD) participating in a 12-month exercise trial. The aim of the project was to determine the feasibility of utilizing a combined synchronous and asynchronous self-administered smartphone application to characterize PD symptoms.

Methods: A synchronous video virtual visit was completed for the administration of virtual Movement Disorder Society-Unified Parkinson's Disease Rating Scale III (vMDS-UPDRS III).

Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury.

Introduction: Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction.

High intensity aerobic exercise improves information processing and motor performance in individuals with Parkinson's disease.

Parkinson's disease (PD) adversely affects information processing and motor performance. The impact of aerobic exercise on modifying the deleterious effects of PD underlying information and motor control processes is not well established. The primary aim of this project was to determine the effects of an 8-week high intensity exercise intervention on information processing and movement execution in individuals with PD.

A validated measure of rigidity in Parkinson's disease using alternating finger tapping on an engineered keyboard.

Introduction: Reliable and accurate measures of rigidity have remained elusive in remote assessments of Parkinson's disease (PD). This has severely limited the utility of telemedicine in the care and treatment of people with PD. It has also had a large negative impact on the scope of available outcomes, and on the costs, of multicenter clinical trials in PD.

Forced and Voluntary Aerobic Cycling Interventions Improve Walking Capacity in Individuals With Chronic Stroke.

Objectives: To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables.

Design: Secondary analysis of data from 2 randomized controlled trials.

Setting: Research laboratory.

Military-Specific Normative Data for Cognitive and Motor Single- and Dual-Task Assessments for Use in Mild Traumatic Brain Injury Assessment.

Introduction: Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military personnel following mild traumatic brain injury is the lack of military-specific normative reference data.

Predictors of Improved Aerobic Capacity in Individuals With Chronic Stroke Participating in Cycling Interventions.

Objective: To determine demographic and physiological factors that predict improvement in aerobic capacity among individuals with chronic stroke participating in cycling interventions.

Design: Secondary analysis of data from 2 randomized clinical trials.

Setting: Research laboratory.

Improvements in temporal and postural aspects of gait vary following single- and multi-modal training in individuals with Parkinson's disease.

Introduction: Gait deteriorates under dual task conditions in individuals with Parkinson's disease (PD). Therapeutic interventions have the potential to improve dual task performance, although it remains unclear how training affects gait performance under varying cognitive domains. The primary aim of this trial was to determine the effect of an 8-week single- or multi-modal gait and cognitive training intervention on dual task performance across cognitive domains in individuals with PD.

Kinematic Metrics from a Wireless Stylus Quantify Tremor and Bradykinesia in Parkinson's Disease.

A fundamental challenge in the clinical care of Parkinson disease (PD) is the current dependence on subjective evaluations of tremor and bradykinesia. New technologies offer the ability to evaluate motor deficits using purely objective measures. The aim of this study was to develop and evaluate the efficacy of a wireless stylus (Cleveland Clinic Stylus) with an embedded motion sensor to quantitatively assess tremor and bradykinesia in patients with PD with subthalamic nucleus (STN) deep brain stimulation (DBS).

A Mobile Device Dual-Task Paradigm for the Assessment of mTBI.

Research Objective: Dual-task performance, in which individuals complete two or more activities simultaneously, is impaired following mild traumatic brain injury. The aim of this project was to develop a dual-task paradigm that may be conducive to military utilization in evaluating cognitive-motor function in a standardized and scalable manner by leveraging mobile device technology.

Methods: Fifty healthy young adult civilians (18-24 years) completed four balance stances and a number discrimination task under single- and dual-task conditions.

Normative Performance on the Balance Error Scoring System by Youth, High School, and Collegiate Athletes.

Context:   Annually, more than 1 million youth athletes in the United States receive or are suspected of receiving a concussion. The Balance Error Scoring System (BESS) is the most commonly used clinical balance evaluation designed to provide a better understanding of the motor-control processes of individuals with concussion. Despite the widespread use of the BESS, a fundamental gap exists in applying this tool to young athletes, as normative values are lacking for this population.

Cleveland Clinic Postural Stability Index Norms for the Balance Error Scoring System.

Introduction: Despite the widespread utilization of the Balance Error Scoring System (BESS) in the evaluation of concussion, it has been criticized for its error-based scoring that is susceptible to floor and ceiling effects and substantial inter-rater variability. A biomechanical outcome, Cleveland Clinic Postural Stability Index (CC-PSI), has been developed as an alternative to subjective BESS scoring. The CC-PSI uses inertial sensor data within a mobile device to provide an objective measure of postural sway during the BESS.

Dual-task Interference Disrupts Parkinson's Gait Across Multiple Cognitive Domains.

Gait dysfunction, a hallmark of Parkinson's disease, contributes to a relatively high incidence of falling. Gait function is further diminished during the performance of a motor-cognitive task (i.e.

Improved lower extremity pedaling mechanics in individuals with stroke under maximal workloads.

Background Individuals with stroke present with motor control deficits resulting in the abnormal activation and timing of agonist and antagonist muscles and inefficient movement patterns. The analysis of pedaling biomechanics provides a window into understanding motor control deficits, which vary as a function of workload. Understanding the relationship between workload and motor control is critical when considering exercise prescription during stroke rehabilitation.