Science Based Rehabilitation Theories into Practice by Kathryn Refshauge

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249 Index Page numbers suffixed by ‘f’ refer to American College of Sports Medicine, sensory cues, 32 figures; page numbers suffixed by ‘t’ exercise screening, 144 sitting, 31 refer to tables. vs. indicates a training, 41–42 comparison. ‘ankle compensation strategy’, 190 balance assessment, 29–41 ankle dorsiflexion, gait training, 177, ankle strategy, 31 A clinical measures, 33–41, 35–37t, 178f, 179–181 abnormal muscle tone, post-stroke, ankle–foot orthosis, gait training, 181 39–40 72–73 ankle joint plantarflexion, gait training, age-related, 33–34 Berg Balance Scale, 33, 36t, 40 accuracy, upper limb assessment, 180 Clinical Test of Sensory 26–27 ankle strategy, balance assessment, 31 Integration of Balance, 36t ankle stretch, contracture therapy, 126 dynamic tasks, 34 Activities–Balance Completion Scale Ashworth Scale, spasticity assessment, Four Square Step Test, 33, 37t (ABC), locomotion evaluation, Functional Obstacle Course, 33 213 93–94 Functional Reach Test, 35t assessment, knowledge-based, 15–48; Motor Assessment Scale, 33 activities of daily living, Parkinson’s Multi-direction Reach Test, 37t disease see Parkinson’s see also specific anatomy; specific Multiple Tasks Test, 37t disease conditions Problem Oriented Mobility clinical decision making process, Assessment, 33 aerobic fitness, see cardiorespiratory 16, 17f static tasks, 34 fitness training functional, 16 Step Test, 35t options, 18–19 studies, 34, 38–39 aerobic fitness/training, see also measurement scales, 19 Timed Up and Go Test, 35t cardiorespiratory fitness observation-based, 18–19 dual tasking, 32, 40–41 training; exercise; specific ordinal scales, 19 floor effects, 40 exercises performance-based, 19 hip strategy, 31 principles, 15–16 in neurological rehabilitation, 29–30 post-stroke, 133 qualities assessed, 17–18 patient’s functional level, 39–40 pre vs. post exercise training, therapy efficacy, 16 stepping strategy, 31 143–144 Assessment of Life Habits (Life-H), Barthel Ambulation subscale, locomotion evaluation, 216–217 locomotion evaluation, 210 strength training vs., see strength Assessment of Quality of Life (AQoL), behavioural therapy, Parkinson’s training 17 disease, 237 Berg Balance Scale, 33, 36t, 40 Affected Leg Stepping condition, B locomotion evaluation, 210 locomotion evaluation, 213 biofeedback techniques, muscle balance weakness rehabilitation, 103 Affected Leg Supporting condition, assessment, see below biomechanics, gait training, 162–163, locomotion evaluation, 213 definition, 30 163f dynamic, 31 akinesia, Parkinson’s disease, 225, 231, limit of stability, 31–32 237 Parkinson’s disease, 225 Alberta Infant Motor Scale Peabody Developmental Motor Scales vs., 58 Test of Infant Motor Performance, 58

250 Index blood pressure monitoring, post-stroke screening, 144 definition, 100 exercise training, 149 structured programmes, 143–144 post-stroke, 95–97 Bobath training, see home-based, 140 assessment, 97f, 100 neurodevelopmental therapy stretching/callisthenics, 140 disability contribution, 99 (NDT) ‘cardiorespiratory reserve’, 136–141 muscle weakness vs., 100 centre of foot pressure (COP), rise-to- rehabilitation, see stroke body-weight support, treadmill walk, 209f, 210, 211f rehabilitation training. see treadmill walking, cerebral palsy double-support phase, gait training, post-stroke assessment, see infant motor 182 performance drug effects, cardiorespiratory fitness brain plasticity monitoring, strength training, 10 training, 148 locomotion training, 198 cerebral plasticity, infant motor dual tasks, balance assessment, 32, performance, 49, 50–51, 61–62 40–41 Brazelton Neonatal Behavioral Chedoke–McMaster Stage of recovery, dynamic balance, 31 Assessment Scale (NBAS), 52 exercise screening, 145 Dynamic Gait Index, 213 chronometric testing, 198–199, 199f dynamic muscle contractions, post- C clinical studies/trials stroke, 71–72, 72f contracture therapy, 125–126 dynamic systems, infant motor cardiopulmonary deterioration, stretching, see stretching, muscle performance, 53–54 Parkinson’s disease, 225 responses dynamic tasks, balance assessment, 34 Clinical Test of Sensory Integration of dynamometry, post-stroke muscle cardiorespiratory fitness, post-stroke, Balance, 36t power, 79–80 see stroke, cardiorespiratory coding categories, upper limb dysarthria, Parkinson’s disease, 232 fitness assessment, 21, 21t dyskinesia, Parkinson’s disease, 225, collagen, in tendons, 113–114 231, 234 cardiorespiratory fitness training, comorbidities, post-stroke dysphagia 136–143; see also aerobic cardiorespiratory fitness levodopa, 238 fitness/training; individual training, 146 Parkinson’s disease, 233 exercise programmes compliance, stretching, 111–103 content validity, Test of Infant Motor E aerobic fitness, 136–141, 138f Performance, 55 exercise recovery time, 137 contractile muscle speed, post-stroke, ‘effort’, upper limb assessment, 28–29 exercise testing, 136–137 76–78, 77f elastic responses, stretching, see heart rate, 137 contracture sensomotor functions, 140 assessment, 91, 93–94 stretching, muscle responses strength training vs., 137 characteristics, 90–92 electrocardiography (ECG), post- definition, 107–108 assessment, 145 disability contribution, 92–93 stroke exercise training, 149 ‘cardiorespiratory reserve’, 136–141 immobilization effects, 120–121 electromyography (EMG) dexterity, 142–143 spasticity vs., 91–92 exercise modes, 145–146 therapy, 94–95 contracture assessment, 93–94 clinical trials, 125–126 development, 2 biofeedback-paced cycling, sitting, 95, 96f muscle performance post-stroke, 153–154 stretching, 124–127 elliptical trainers, 145 coronary artery disease, post-stroke, 73, 74 isokinetic cycle training, 139–140 132–133 power outputs, 79, 79f isokinetic cycling, see isokinetic creep, stretching, 116–118 Elicited Items, Test of Infant Motor cycling ‘cross-bridge population displacement Performance, 54–55 Odstock RES walking, 154 mechanism’, 115 elliptical trainers, exercise training stepping machines, 145 cycling, see isokinetic cycling post-stroke, 145 treadmill walking, 138–139, endurance levels, stroke patient, 9–10 139–140, 139f, 145–146 D endurance training, see also specific vertical climbers, 145 modes of training implementation, 149–150 deconditioning, stroke patients, 10 locomotion training, 191–192 patient structured, 149–150 depression, post-stroke, 141 post-stroke, 191–192 ‘total exercise dose’, 150 dexterity spasticity vs., 191–192 monitoring, 149 energy levels, gait training, 162–164, muscle weakness, 142–143 cardiorespiratory fitness training, 164f, 165f prescription, 146–149, 147t 142–143 exercise cycling, see isokinetic cycling comorbidities, 146 exercise recovery time, 137 drug effects, 148 exercise testing, post-stroke, 134–135, rating of perceived exertion, 148 135–136, 136–137, 137 systolic blood pressure measurements, 148–149 psychosocial improvements, 141–142

Index 251 exercise therapy, see also specific training muscle groups, 172–173 sarcomeres, 121–122 methods/equipment strengthening, 175f, 175–176 stretch, muscle response, 119, 119f, targeting, 173–175 clinical studies, 123f 120–121 intensity, 9–10 Saunders’ determinants, 164–165 tendons, 120–121, 122 Parkinson’s disease, 234–236, slow walking, 166 infant motor performance stance phase, 178–182 assessment, 49–65 239–240 Bobath training, 236 ankle dorsiflexion, 177, 178f, Test of Infant Motor home programmes, 235 179–181 Performance, see Test of Infant karate, 235 ankle–foot orthosis, 181 Motor Performance stretching, 235 ankle joint plantarflexion, 180 plasticity/intervention, 49, 50–51 trunk muscle training, 235 hip extension, 180–181 rehabilitation theory testing, 60–63 post-stroke, clinical studies, knee bending, 177–179 early vs. late therapy, 61, 62 123–124 push-off, 180 head control, 62 Extended Disability Status Scale for swing phase, 182 imaging studies, 61 Patients with Multiple Sclerosis, walking speed vs. gait, 161–163, 177 leg movements, 62–63 17 General Movement Assessment, infant neurodevelopmental therapy, 60 motor performance, 53 plasticity effects, 61–62 F goals (of therapy), 7–8 Tscharnuter Akademie for Movement Organization falls, see also balance H therapy, 60 Parkinson’s disease, 29–30, 231–232 responsive measures, 51–54 polio, 30 hamstring muscles, stroke, 69, 69f Brazelton Neonatal Behavioral risk groups, 41–42 handicap, in locomotion, 213–215 Assessment Scale, 52 stroke patients, 29 Handicap Assessment and Resource dynamic systems, 53–54 vestibular dysfunction, 30 General Movement Assessment, Tool (HART), 18 53 fascicles, see muscle fascicles handwriting, Parkinson’s disease, 228 Movement Assessment of ‘filamentary resting tension’, 115 head control, infant motor Infants, 52–53 floor effects, balance assessment, 40 neurodevelopmental therapy, 52 fluidity index (FI), 207 performance, 62 observational categories, 51–52 ‘fluid motor strategy’, 207 ‘heart rate reserve’, 146–148 Supplemental Motor Test, 52 focus training, development, 6–7 heart rates, post-stroke, 135 initiating gait, locomotion training, Four Square Step Test (FSST), 33, 37t 208–210 Fugl-Meyer leg subscale, locomotion cardiorespiratory fitness training, 137 International Classification of hip extension, gait training, 180–181 Impairment, Disability and evaluation, 210 ‘hip strategy compensation’, 190 Handicap (ICDIH), 18 functional electrical stimulation (FES), isokinetic cycling, 146, 152, 152f, balance assessment, 31 153–154, 154f isokinetic cycling, 153–154, 154f home programmes exercise training post-stroke, 146 Functional Independence Measure, 17 functional electrical stimulation, Functional Obstacle Course, 33 Parkinson’s disease exercise 153–154, 154f Functional Reach Test, 35t therapy, 235 post-stroke cardiorespiratory fitness training, 139–140 clinical trials, 38, 39 strength/endurance training, isometric contractions, post-stroke, see 193–194 stroke, muscle performance G hypertonia J gait, see also walking assessment, 91 definition, 161–164 causes, 91 joint moments, walking, 168f initiation definition, 72 definition, 208 spasticity vs., 90–91 K locomotion training, 208–210 preparatory adjustments, 208, hypokinesia, Parkinson’s disease, 225, karate, Parkinson’s disease exercise 210, 211f 231, 237 therapy, 235 kinetic analysis, 189–190 Parkinson’s disease, 219–230, 229f, hypomimia, Parkinson’s disease, kinetic analysis (kinematics) 230f 232–233 definition, 20 gait, 189–190 gait training, 159–184 I biomechanics, 162–163, 163f double-support phase, 182 imaging studies energy levels, 164–165, 164f, 165f infant motor performance, 61 locomotion training, 196–197, 197f immobilization effects contracture, 120–121 fascicles, 120–121

252 Index kinetic analysis (kinematics) (Continued) mental practice, locomotion training, post-stroke, 98–99 stroke patients, 23–24t 195–202 assessment, 99–100 walking, 166–168, 167f definition, 98 brain plasticity monitoring, 198 dexterity vs., 100 knee flexion chronometric testing, 198–199, 199f disability contribution, 99 contracture therapy, clinical trials, imaging studies, 196–197, 197f rehabilitation, see stroke 125 motor imagery, 196–197, 197f rehabilitation gait training, 177–179 questionnaires, 199 swing phase, 182 working memory effects, 200–202, stroke patients, see stroke, muscle performance kyphosis, Parkinson’s disease, 225 201f, 202f micrographia, Parkinson’s disease, 228 training, see strength training L mobility, assessment, 16 muscle–tendon units, stretching, Modified Ashworth Scale (MAS), 73 leg movements, infant motor Motor Assessment Scale, 33 109–110, 110f performance, 62–63 musculoskeletal impairment, exercise screening, 145 levodopa, dysphagia, 238 motor imagery, locomotion training, Parkinson’s disease, 225 lift-off, gait training, 180–181 limit of stability (LOS), 31–32 196–197, 197f N locomotion, post stroke, 187–222, see motor learning neurodevelopmental therapy also specific training methods research, 5–6 (NDT), 1, 2 compensation, 172 virtual reality training, 204 evaluation, 210, 212–215 motor recovery mechanisms, 5 development, 1 Motor Relearning Programme for infant motor performance, 52, 60 Activities–Balance Completion Parkinson’s disease exercise Scale, 213 Stroke, 68, 89 Affected Leg Stepping Movement Assessment of Infants therapy, 238 condition, 213 neurophysiological therapy, Affected Leg Supporting (MAI), 52–53 condition, 213 Multi-direction Reach Test, 37t development, 1, 2 Assessment of Life Habits, multidisciplinary rehabilitation, non-neural muscle tone, post-stroke, 216–217 Barthel Ambulation subscale, 210 Parkinson’s disease, 241–243 73 Berg Balance Scale, 210 Multiple Tasks Test, 37t Nottingham Health Profile, 142 Dynamic Gait Index, 213 multitasking, Parkinson’s disease, Fugl-Meyer leg subscale, 210 O Step Test, 212–213, 214f 228–229 Timed Stair Test, 212 muscle(s) observation-based assessment, 18–19 increased practice time, 194–205 infant motor performance, 51–52 kinematics, 23–24t anatomy, 109–110 muscle groups, 171–172 groups Observed Items, Test of Infant Motor power patterns, 171–172 Performance, 54–55 task-oriented training, 186–194, gait training, see gait training 206–210 walking post-stroke, 171–172 occupational therapy, Parkinson’s endurance training, 191–192 power output, post-stroke, 78–80, disease, 238–239, 242 initiating gait, 208–210 79f rising to walk, 206–208 soreness, stretch effects, 123–124, Odstock RES walking, 154 strength/endurance training 123f ordinal scales, knowledge-based combination, 193–194 stretching response, see stretching, locomotor dysfunctions, Parkinson’s muscle responses assessment, 19 disease, 231 muscle fascicles definition, 109–110 P M immobilization effects, 120–121 muscle length changes, 110f, paresis, see muscle strength maximal effort tests, exercise 111–112, 112f Parkinson’s disease, 223–248 screening, 144 muscle fibres mechanical properties, 114 activities of daily living, 228–233 maximum angular velocity, post- post-stroke, 78 exercise therapy, 239–240 stroke, 76–77, 77f titin, 116 falls, 29–30, 231–232 muscle length changes gait, 229–230, 229f, 230f measurement scales, knowledge-based fascicles, 110f, 111–112, 112f handwriting, 228 assessment, 19 stretching, 110f, 111–112 movement strategies, 240–241 tendons, 111–113 multitasking, 228–229 muscle strength treatment, 239–241 cardiorespiratory fitness training, 142–143 exercise therapy, see exercise cerebral palsy, 10 therapy Parkinson’s disease, 226 impairments, 224–228

Index 253 akinesia, 225, 231, 237 neurophysiological therapy, 1 S cardiopulmonary deterioration, new developments, 1–2 225 performance adaption, 7 sarcomeres dysarthria, 232 rehabilitation environment, 8 immobilization effects, 121–122 dyskinesia, 225, 231, 234 spasticity, 3–4 post-stroke, 77–78 dysphagia, 233 task-oriented training, 8–9 exercise therapy, see exercise plasticity, infant motor performance, Saunders’ determinants, gait training, therapy 164–165 hypokinesia, 225, 231, 237 49, 50–51, 61–62 hypomimia, 232–233 pneumonia, Parkinson’s disease, screening, post-stroke kyphosis, 225 cardiorespiratory fitness locomotor dysfunctions, 231 225–226 training, 144 micrographia, 228 polio, fall incidence, 30 movement, 225, 226–227 postural control, see balance sensiomotor functions, post-stroke movement strategies, 236–238 power patterns cardiorespiratory fitness muscle weakness, 226 training, 140 musculoskeletal impairment, walking, 167–170, 169f, 170f 225 walking post-stroke, 171–172 serial casts, contracture therapy, 126 pneumonia, 225–226 preparatory adjustments, gait ‘short range elastic component’, postural instability, 225 postural responses, 227–228 initiation, 208, 210, 211f 114–115 proprioceptive mechanisms, 227 Problem Oriented Mobility shoulder positioning, contracture therapy, 233–239 multidisciplinary rehabilitation, Assessment, 33 therapy, 125 241–243 proprioceptive mechanisms, sitting balance, definition, 31 occupational therapy, 238–239, 242 slow walking, gait training, 166–167 pathology, 224–225 Parkinson’s disease, 227 spasticity, 3–4 societal role restrictions, 233 proprioceptive neuromuscular treatment, 241 assessment, 89–90, 91, 93–94 speech therapy, 238–239 facilitation (PNF), 1, 2 Ashworth Scale, 93–94 swallowing therapy, 238–239 post-stroke, 67–68 passive stretch, 90, 90f Parkinson’s Home Visiting Assessment psychosocial improvements, post- Tardieu scale, 94 Tool, 239–240 partial body weight support (PBWS) stroke cardiorespiratory fitness characteristics, 89–90 gait training, 151–152 training, 141–142 contracture vs., 91–92, 96f treadmill training, 186, 188–189, push-off, gait training, 180–181 definition, 71, 72, 89 237–238 disability contribution, 92–93 passive length–tension curves, Q stretching, 108, 109f stretch reflex, 92–93 passive movements, post-stroke, 73, quadriceps muscles walking, 92 73f post-stroke, 75–76, 75f endurance training vs., 191–192 passive stretch, spasticity assessment, stroke, 69 hypertonia vs., 90–91 90, 90f measurement, 73 Peabody Developmental Motor Scales, quality of life Modified Ashworth Scale, 73 Alberta Infant Motor Scale vs., assessment, 16 strength training vs., 191 58 post-stroke, exercise training therapy, 94–95 peak oxygen uptake (VO2peak), post- effects, 141–142 speech therapy, Parkinson’s disease, stroke, 133–134, 134f, 135 238–239 cardiorespiratory fitness training, questionnaires, locomotion training, speed, walking, 171 136–137, 143–144 201f splinting, contracture therapy, 126 peak velocity (PV) timing, upper limb stance phase, gait training, see gait assessment, 24 R training performance-based assessment, 19 static tasks, balance assessment, 34 physiotherapy, 1–13; see also specific Rasch psychometric analysis, Test of stepping machines, exercise training methods/practices Infant Motor Performance, 55 post-stroke, 145 goals, 7–8 stepping strategy, balance assessment, history/development, 1–3 rating of perceived exertion (PRE), 31 motor learning research, 5–6 post-stroke cardiorespiratory Step Test, 35t motor recovery mechanisms, 5 fitness training, 148 clinical trials, 38, 39 locomotion evaluation, 212–213, 214f reflex hyperexcitability, see spasticity strength loss, see muscle strength rehabilitation environment, strength training cerebral palsy, 10 importance, 8 development, 5 rise-to-walk (RTW), 209 gait training, 173t, 175–176 post-stroke, see stroke rehabilitation centre of foot pressure, 209f, 210, 211f spasticity vs., 189 locomotion training, 206–208 training, 207, 208–210, 210f robotized gait-trainers, treadmill training, 187

254 Index stress relaxation, stretching, 116, 117, negative impairments, 95–103; see systolic blood pressure measurements, 118 also specific impairments post-stroke cardiorespiratory definition, 87 fitness training, 148–149 stretching contracture therapy, 124–127 positive impairments, 87–103; see T Parkinson’s disease exercise also specific impairments therapy, 235 definition, 87 Tardieu scale, spasticity assessment, 94 task-oriented training, 8–9; see also stretching, muscle responses, 107–130 spasticity, see spasticity adaptive responses, 118–122 weakness, see stroke, muscle locomotion, post stroke growth, 118–119 cerebral palsy, 10 immobilization effects, 119, 119f, performance locomotion, see locomotion, post 120–121 stroke, muscle performance, 67–85, 68 clinical studies, 122–127 stroke contracture effects, 124–127 abnormal tone, 72–73 tendons exercise, 123–124, 123f causes, 70 injury risk, 124 clinical studies, 68–70 collagen, 113–114 normal movement, 125 dynamic contractions, 71–72, 72f immobilization effects, 120–121, 122 elastic responses, 108–116 function relationship, 80 muscle length changes, 111–113 compliance, 111–103 isometric contractions, 69, 69f, Test of Infant Motor Performance muscle length changes, 110f, 111–112 70–71, 71f (TIMP), 51, 54–58 muscle–tendon units, 109–110, twitch superimposition Alberta Infant Motor Scale vs., 58 110f technique, 74 clinical practice applications, 58–60 passive length–tension curves, muscle antagonist co-contraction, 108, 109f 70–72 condition validity, 59–60 structural determinants, 113–116 muscles affected, 69–70, 73 home applications, 59 viscous responses, 116–118, 117f non-neural muscle tone, 73 clinical studies, 56–57 creep, 116, 118 passive movements, 73, 73f content validity, 55 stress relaxation, 116, 117, 118 power generation, 76–80 Elicited Items, 54–55 contractile speed, 76–78, 77f final form, 57 stretch reflex dynamometry, 79–80 function, 57 contracture, 92–93 electromyography, 73, 74, 79, 79f Observed Items, 54–55 post-stroke, 81, 81t power output, 78–80, 79f predictive validity, 58 spasticity, 92–93 voluntary activation, 73–76 Rasch psychometric analysis, 55 failure mechanisms, 74–75 therapeutic stretch. see stretching stroke quadriceps muscle, 75–76, 75f Timed Stair Test (TST), locomotion cardiorespiratory fitness, see stroke, twitch superimposition evaluation, 212 cardiorespiratory fitness technique, 74 Timed Up and Go Test, 17, 35t, depression, 141 stroke rehabilitation 206–207, 208f dexterity, see dexterity dexterity, 100–103, 101t clinical trials, 38, 39 fall incidence, 29 applicability, 103 timing, upper limb assessment, 27–28 kinematics, 23–24t monitoring, 103 titin, 116 locomotion, see locomotion, post gait training, see gait training ‘total exercise dose’, post-stroke stroke locomotion, see locomotion, post cardiorespiratory fitness stroke training, 150 stroke, cardiorespiratory fitness, Motor Relearning Programme for training, see specific training methods 131–158 Stroke, 89 treadmill walking, see also walking muscle weakness, 100–103, 101t, body-weight support, 237–238 assessment, 133–135 102f Parkinson’s disease, 237–238 exercise testing, 134–135, biofeedback techniques, 103 treadmill walking, post-stroke, 135–136, 137 monitoring, 103 138–139, 139–140, 139f, 145–146, strength training, 80–81, 189–191 186–189 chronic stroke, 135–136 aerobic training vs., 141–142 acute vs. chronic stroke, 187–189 deconditioning, 10 cardiorespiratory fitness body-weight support, 186 endurance levels, 9–10 training vs., 137 clinical trials, 188–190 factors, 132–133 clinical trials, 190–191 robotized gait-trainers, 187 stretch reflex changes, 81, 81t trunk muscle training, Parkinson’s coronary artery disease, walking speed, 190–191 disease exercise therapy, 235 132–133 Supplemental Motor Test (SMT), infant Tscharnuter Akademie for Movement environmental factors, 133 motor performance, 52 Organization (TAMO) therapy, subacute stroke, 133–135 swallowing therapy, Parkinson’s infant motor performance, 60 training, see cardiorespiratory disease, 238–239 twitch superimposition technique, 74 fitness training swing phase, 182 stroke, motor impairments, 87–106 contracture, see contracture dexterity loss, see dexterity

Index 255 U visual cues, 20–21 W clinical implications, 27–29 Unified Parkinson’s Disease Rating walking, 166–171; see also gait; Scale (UPDRS), 17, 242 V treadmill walking upper limb assessment, 20–25 vertical climbers, exercise training age-dependence, 170 characteristics, 20–27 post-stroke, 145 joint moments, 168f abnormal function, 27 kinetic analysis, 166–168, 167f accuracy, 26–27 vestibular dysfunction, fall incidence, post-stroke (see locomotion, post changes with therapy, 24–26, 30 25t stroke) coding categories, 21, 21t virtual reality training, 203–205, 205f power patterns, 167–170, 169, 170f ‘effort’, 28–29 motor learning, 204 spasticity, 92 identification, 27 speed, 170 peak velocity timing, 24 viscous responses, see stretching, suboptimal vs. optimal muscle responses strength training, 190–191 performance, 22, 23–24t, 24–26 Webster Disability Scale, 240 timing, 27–28 visual cues, upper limb assessment, working memory effects, 20–21 locomotion training, 200–202, voluntary activation, post-stroke, see 201f, 202f stroke, muscle performance