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Neurological Therapy & Brain

Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: A Randomized Controlled Pilot Trial

Neuropsychology. Advance online publication. doi: 10.1037/a0034117
Online First Publication, September 23, 2013. doi: 10.1037/a0034117

Lonnie A. Nelson, Margaret MacDonald, Christina Stall, and Renee Pazdan


Objective: We report preliminary findings on the efficacy of interactive metronome (IM) therapy for theremediation of cognitive difficulties in soldiers with persisting cognitive complaints following blast-related mild-to-moderate traumatic brain injury (TBI). Method: Forty-six of a planned sample of 50 active duty soldiers with persistent cognitive complaints following a documented history of blast-related TBI of mild-to-moderate severity were randomly assigned to receive either standard rehabilitation care(SRC) or SRC plus a 15-session standardized course of IM therapy. Primary outcome measures were Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Index Scores. Secondary outcome measures included selected subtests from the Delis–Kaplan Executive Functioning System (Trail Making Test and Color–Word Interference) and the Wechsler Adult Intelligence Scale–Fourth Edition (Symbol Search, Digit–Symbol Coding, Digit Span, and Letter–Number Sequencing) as well as the Integrated Visual and Auditory Continuous Performance Test. Results: Significant group differences(SRC vs. IM) were observed for RBANS Attention (p  .044), Immediate Memory (p  .019), and Delayed Memory (p  .031) indices in unadjusted analyses, with the IM group showing significantly greater improvement at Time 2 than the SRC group, with effect sizes in the medium-to-large range in the adjusted analyses for each outcome (Cohen’s d  0.511, 0.768, and 0.527, respectively). Though not all were statistically significant, effects in 21 of 26 cognitive outcome measures were consistently in favor of the IM treatment group (binomial probability  .00098). Conclusion: The addition of IM therapy to SRC appears to have a positive effect on neuropsychological outcomes for soldiers who have sustained mild-to-moderate TBI and have persistent cognitive complaints after the period for expected recovery has passed.

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Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury-A Randomized Controlled Pilot Trial _Nelson et al. Neuropsychology Sep 23 2013




Motor Imagery in Physical Therapist Practice 2007

Journal of the American Physical Therapy Association

  1 May 2007 doi: 10.2522/​ptj.20060331    Physical Therapy July 2007 vol. 87 no. 7 942-953                                    

Motor Imagery in Physical Therapist Practice

Ruth Dickstein and  Judith E Deutsch

Author Affiliations

  1. R Dickstein, PT, DSc, is Associate Professor, Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel 31905, Haifa, Israel

  2. JE Deutsch, PT, PhD, is Professor and Director of the Rivers Lab, Doctoral Programs in Physical Therapy Department of Developmental and Rehabilitative Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ

Address all correspondence to Dr Dickstein at:


Motor imagery is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published. The purpose of this update is to synthesize the relevant literature about motor imagery in order to facilitate its integration into physical therapist practice. This update also will discuss visual and kinesthetic motor imagery, factors that modify motor imagery practice, the design of motor imagery protocols, and potential applications of motor imagery.

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Motor Imagery in Physical Therapist Practice 2007

Neurological Therapy & Motor Skills

Noninvasive cortical stimulation enhances motor skill acquisition over multiple days through an effect on consolidation  (Neurological Therapy)

Early Edition > Janine Reis, doi: 10.1073/pnas.0805413106  National Academy of Science of USA

Edited by Emilio Bizzi, Massachusetts Institute of Technology, Cambridge, MA, and approved November 25, 2008 (received for review June 5, 2008)


Motor skills can take weeks to months to acquire and can diminish over time in the absence of continued practice. Thus, strategies that enhance skill acquisition or retention are of great scientific and practical interest. Here we investigated the effect of noninvasive cortical stimulation on the extended time course of learning a novel and challenging motor skill task. A skill measure was chosen to reflect shifts in the task’s speed–accuracy tradeoff function (SAF), which prevented us from falsely interpreting variations in position along an unchanged SAF as a change in skill. Subjects practiced over 5 consecutive days while receiving transcranial direct current stimulation (tDCS) over the primary motor cortex (M1). Using the skill measure, we assessed the impact of anodal (relative to sham) tDCS on both within-day (online) and between-day (offline) effects and on the rate of forgetting during a 3-month follow-up (long-term retention). There was greater total (online plus offline) skill acquisition with anodal tDCS compared to sham, which was mediated through a selective enhancement of offline effects. Anodal tDCS did not change the rate of forgetting relative to sham across the 3-month follow-up period, and consequently the skill measure remained greater with anodal tDCS at 3 months. This prolonged enhancement may hold promise for the rehabilitation of brain injury. Furthermore, these findings support the existence of a consolidation mechanism, susceptible to anodal tDCS, which contributes to offline effects but not to online effects or long-term retention.