Medicine and Health Sciences Commons^™

Hybrid Diffuse Optical Techniques For Continuous Hemodynamic Measurement In Gastrocnemius During Plantar Flexion Exercise, Brad Henry, Mingjun Zhao, Yu Shang, Tim L. Uhl, D. Travis Thomas, Eleftherios S. Xenos, Sibu P. Saha, Guoqiang Yu

Physical Therapy Faculty Publications

Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of foreann muscle hemodynamics during handgrip exercises. The translation of these techniques from the foreann to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin poncentrations, blood oxygen …

Reliability Of 3-Dimensional Measures Of Single-Leg Cross Drop Landing Across 3 Different Institutions: Implications For Multicenter Biomechanical And Epidemiological Research On Acl Injury Prevention, Christopher A. Dicesare, Nathaniel A. Bates, Kim D. Barber Foss, Staci M. Thomas, Samuel C. Wordeman, Dai Sugimoto, Benjamin D. Roewer, Jennifer M. Medina Mckeon, Stephanie Di Stasi, Brian W. Noehren, Kevin R. Ford, Adam W. Kiefer, Timothy E. Hewett, Gregory D. Myer

Physical Therapy Faculty Publications

Background: Anterior cruciate ligament (ACL) injuries are physically and financially devastating but affect a relatively small percentage of the population. Prospective identification of risk factors for ACL injury necessitates a large sample size; therefore, study of this injury would benefit from a multicenter approach.

Purpose: To determine the reliability of kinematic and kinetic measures of a single-leg cross drop task across 3 institutions.

Study Design: Controlled laboratory study.

Methods: Twenty-five female high school volleyball players participated in this study. Three-dimensional motion data of each participant performing the single-leg cross drop were collected at 3 institutions over a period of 4 …

Sustained Isometric Shoulder Contraction On Muscular Strength And Endurance: A Randomized Clinical Trial, Natalie L. Myers, Jenny L. Toonstra, Jacob S. Smith, Cooper A. Padgett, Tim L. Uhl

Physical Therapy Faculty Publications

BACKGROUND: The Advanced Throwers Ten Exercise Program incorporates sustained isometric contractions in conjunction with dynamic shoulder movements. It has been suggested that incorporating isometric holds may facilitate greater increases in muscular strength and endurance. However, no objective evidence currently exists to support this claim.

HYPOTHESIS/PURPOSE: The purpose of this research was to compare the effects of a sustained muscle contraction resistive training program (Advanced Throwers Ten Program) to a more traditional exercise training protocol to determine if increases in shoulder muscular strength and endurance occur in an otherwise healthy population. It was hypothesized that utilizing a sustained isometric …

Reduced Voluntary Running Performance Is Associated With Impaired Coordination As A Result Of Muscle Satellite Cell Depletion In Adult Mice, Janna R. Jackson, Tyler J. Kirby, Christopher S. Fry, Robin L. Cooper, John J. Mccarthy, Charlotte A. Peterson, Esther E. Dupont-Versteegden

Physical Therapy Faculty Publications

BACKGROUND: Satellite cells, or muscle stem cells, have been thought to be responsible for all muscle plasticity, but recent studies using genetically modified mouse models that allow for the conditional ablation of satellite cells have challenged this dogma. Results have confirmed the absolute requirement of satellite cells for muscle regeneration but surprisingly also showed that they are not required for adult muscle growth. While the function of satellite cells in muscle growth and regeneration is becoming better defined, their role in the response to aerobic activity remains largely unexplored. The purpose of the current study was to assess the …

Reliability Of Isometric And Eccentric Isokinetic Shoulder External Rotation, Brianna M. Papotto, Thomas Rice, Terry Malone, Timothy Butterfield, Tim L. Uhl

Physical Therapy Faculty Publications

CONTEXT: Shoulder external rotators are challenged eccentrically throughout the deceleration phase of throwing which is thought to contribute to overuse injuries. In order to evaluate the effectiveness of intervention programs as well as identify deficits, reliable and responsive measures of isometric and eccentric shoulder external rotation are necessary. Previously, isometric measures have primarily tested a single position and eccentric measures have not been found to have high reliability.

OBJECTIVE: To examine the between day reliability of multiple angle isometric and dynamic eccentric isokinetic testing of shoulder external rotation.

DESIGN: Repeated measures Participants: 10 healthy subjects (age: 30 ± 12 years, …

Residual Impact Of Previous Injury On Musculoskeletal Characteristics In Special Forces Operators, Jeffrey J. Parr, Nicholas C. Clark, John P. Abt, Julie Y. Kresta, Karen A. Keenan, Shawn F Kane, Scott M. Lephart

Physical Therapy Faculty Publications

Background: Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury.

Purpose: To identify the residual impact of previous injury on musculoskeletal characteristics.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based …

Breast Cancer Rehabilitation: Clinical Examination And Outcomes Assessment, Nicole L. Stout, Shana Harrington, Lucinda Pfalzer, Mary Insana Fisher

Physical Therapy Faculty Publications

Breast cancer is the most commonly diagnosed cancer in women in the United States. The treatment for breast cancer occurs along a protracted time period and includes many different disease treatment modalities. These treatments carry with them a large number of adverse effects that negatively impact function in both the short term and long term. It is necessary for rehabilitation providers to interface with patients being treated for breast cancer throughout the continuum of care so that interval assessments can be conducted to identify emerging impairments and alleviate disability. To achieve this, the rehabilitation provider must have an understanding of …

Home Exercise Adherence In An Underserved Ecuadorian Community, Joseph M. Day, Jean Irion, Meridith Anile, Jared Henson, Ben Roussel, Christina Shepherd, Huybrechts Bindele

Physical Therapy Faculty Publications

Purpose: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more commonplace. Patients in underserved regions are not likely to receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population.

Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from …

Increasing Ball Velocity In The Overhead Athlete: A Meta-Analysis Of Randomized Controlled Trials, Natalie L. Myers, Aaron D. Sciascia, Philip M. Westgate, William B. Kibler, Tim L. Uhl

Physical Therapy Faculty Publications

Overhead athletes routinely search for ways to improve sport performance, and one component of performance is ball velocity. The purpose of this meta-analysis was to investigate the effect of different strengthening interventions on ball and serve velocity. A comprehensive literature search with pre-set inclusion and exclusion criteria from 1970 to 2014 was conducted. Eligible studies were randomized control trials including the mean and SDs of both pretest and posttest ball velocities in both the experimental and the control groups. The outcome of interest was ball/serve velocity in baseball, tennis, or softball athletes. Level 2 evidence or higher was investigated …

Reliability Of Strength And Performance Testing Measures And Their Ability To Differentiate Persons With And Without Shoulder Symptoms, Aaron Sciascia, Tim L. Uhl

Physical Therapy Faculty Publications

BACKGROUND: Upper extremity physical performance measures exist but none have been universally accepted as the primary means of gauging readiness to return to activity following rehabilitation. Few reports have described reliability and/or differences in outcome with physical performance measures between individuals with and without shoulder symptoms.

HYPOTHESES/PURPOSE: The purpose of this study was to establish the reliability of traditional upper extremity strength testing and the CKCUEST in persons with and without shoulder symptoms as well as to determine if the testing maneuvers could discriminate between individuals with and without shoulder symptoms. The authors hypothesized that strength and physical …

Do Three Different Passive Assessments Of Quadriceps Spasticity Relate To The Functional Activity Of Walking For Children Diagnosed With Cerebral Palsy?, Hank White, Tim L. Uhl, Sam Augsburger

Physical Therapy Faculty Publications

A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression …

Less Is More: The Physiological Basis For Tapering In Endurance, Strength, And Power Athletes, Kevin A. Murach, James R. Bagley

Physical Therapy Faculty Publications

Taper, or reduced-volume training, improves competition performance across a broad spectrum of exercise modes and populations. This article aims to highlight the physiological mechanisms, namely in skeletal muscle, by which taper improves performance and provide a practical literature-based rationale for implementing taper in varied athletic disciplines. Special attention will be paid to strength- and power-oriented athletes as taper is under-studied and often overlooked in these populations. Tapering can best be summarized by the adage “less is more” because maintained intensity and reduced volume prior to competition yields significant performance benefits.

Assessment Of Accelerometers For Measuring Upper-Extremity Physical Activity, Elizabeth Lawinger, Timothy L. Uhl, Mark Abel, Srinath Kamineni

Physical Therapy Faculty Publications

Objective: The overarching goal of this study was to examine the use of triaxial accelerometers in measuring upper-extremity motions to monitor upper-extremity-exercise compliance. There were multiple questions investigated, but the primary objective was to investigate the correlation between visually observed arm motions and triaxial accelerometer activity counts to establish fundamental activity counts for the upper extremity.

Study Design: Cross-sectional, basic research.

Setting: Clinical laboratory.

Participants: Thirty healthy individuals age 26 ± 6 y, body mass 24 ± 3 kg, and height 1.68 ± 0.09 m volunteered.

Intervention: Participants performed 3 series of tasks: activities of …

Improving Outcomes By Implementing A Pressure Ulcer Prevention Program (Pupp): Going Beyond The Basics, Amparo Cano, Debbie Anglade, Hope Stamp, Fortunata Joaquin, Jennifer A. Lopez, Lori Lupe, Steven P. Schmidt, Daniel L. Young

Physical Therapy Faculty Publications

A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions …

Arm Dominance Does Not Influence Measures Of Scapular Muscle Strength And Endurance In Healthy Individuals, Joseph M. Day, Heather M. Bush, Arthur J. Nitz, Tim L. Uhl

Physical Therapy Faculty Publications

BACKGROUND PURPOSE: Scapular muscle performance is potentially influenced by arm dominance. The purpose of this study was to investigate the effect of arm dominance on clinical measures of scapulohumeral muscle strength and endurance.
METHODS: Thirty-two healthy individuals between the ages of 30 and 65 years were recruited to participate. Scapular muscle strength of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) were recorded with a hand held dynamometer. One scapulohumeral isometric muscle endurance task was performed in prone. The order of testing (strength and endurance) was randomized for each individual. Dominant to …

A Comparison Of The Upper Limb Lift Test Between Women With Breast Cancer And Healthy Control Subjects, Mary Insana Fisher, Lucinda Pfalzer, Ellen W. Levy, Shana Harrington, Lynn H. Gerber, Nicole L. Stout

Physical Therapy Faculty Publications

Presentation at the World Confederation for Physical Therapy Congress, held May 1-4, 2015, in Singapore.

Background: Objective measures of upper limb (UL) function specific to breast cancer survivors (BC) are limited. Motion, strength, and muscular endurance are measurable components of UL function. A clinical test that quantifies these components is needed.

Purpose: This study compares the Upper Limb Lift Test (ULLT) between women with BC and healthy control subjects (HC) at baseline, 1-3 months, and 12+ months post-operatively enrolled in a prospective surveillance trial with early intervention. A secondary purpose was to validate the ULLT by comparing findings to self-reported …

A Comparison Of The Scapular Flip Test Between Women With Breast Cancer And Healthy Controls, Mary Insana Fisher, Lucinda Pfalzer, Ellen W. Levy, Shana Harrington, Lynn H. Gerber, Nicole L. Stout

Physical Therapy Faculty Publications

Presentation at the World Confederation for Physical Therapy Congress, held May 1-4, 2015, in Singapore.

Background: The Scapular Flip test was designed to screen for spinal accessory nerve palsy. The spinal accessory nerve can be damaged in breast cancer surgery and treatment, resulting in scapular dyskinesis and upper limb (UL) impairment in women with breast cancer (BC). This test could be useful to screen for UL impairment in BC.

Purpose: The purpose of this study was to describe shoulder impairments as defined by a positive Flip Test in a group of women with BC at baseline, 1-3 months, and 12+ …

Descriptive Analysis Of Common Functional Limitations Identified By Patients With Shoulder Pain, Enrique V. Smith-Forbes, Stephanie D. Moore-Reed, Philip M. Westgate, W. Ben Kibler, Timothy L. Uhl

Physical Therapy Faculty Publications

Context: Recent establishment of G-codes by the US government requires therapists to report function limitations at initial evaluation. Limited information exists specific to the most common limitations in patients with shoulder pain.

Objective: To describe the most commonly expressed shoulder limitations with activities and their severity/level of impairment from a patient’s perspective on the initial evaluation.

Design: Descriptive.

Setting: Patients reporting pain with overhead activity and seeking medical attention from one orthopedic surgeon were recruited as part of a cohort study.

Patients: 176 with shoulder superior labral tear from anterior to posterior (SLAP), subacromial impingement, …

Addition Of Hip Exercises To Treatment Of Patellofemoral Pain Syndrome: A Meta-Analysis, Kimberly Morelli, Maria Carrelli, Maria Nunez, Carolina A. Smith, Gordon L. Warren

Physical Therapy Faculty Publications

AIM: To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome.

METHODS: The authors completed a systematic review searching eight databases (i.e. , PubMed, Cochrane, CINHAL, MEDLINE, SportsDiscus, EMBASE, APTA Hooked on Evidence, and PEDro). Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria: subjects had a primary diagnosis of patellofemoral pain syndrome (PFPS), intervention group included hip-strengthening exercises, control group included a traditional physical therapy intervention, study included outcome measures of pain and/or function, study used a randomized controlled trial design, PEDro score …

Immune Function And Muscle Adaptations To Resistance Exercise In Older Adults: Study Protocol For A Randomized Controlled Trial Of A Nutritional Supplement, Richard A. Dennis, Usha Ponnappan, Ralph L. Kodell, Kimberly K. Garner, Christopher M. Parkes, Melinda M. Bopp, Kalpana P. Padala, Charlotte A. Peterson, Prasad R. Padala, Dennis H. Sullivan

Physical Therapy Faculty Publications

BACKGROUND: Immune function may influence the ability of older adults to maintain or improve muscle mass, strength, and function during aging. Thus, nutritional supplementation that supports the immune system could complement resistance exercise as an intervention for age-associated muscle loss. The current study will determine the relationship between immune function and exercise training outcomes for older adults who consume a nutritional supplement or placebo during resistance training and post-training follow-up. The supplement was chosen due to evidence suggesting its ingredients [arginine (Arg), glutamine (Gln), and β-hydroxy β-methylbutyrate (HMB)] can improve immune function, promote muscle growth, and counteract muscle loss. …

The Association Between Critical Thinking And Scholastic Aptitude On First-Time Pass Rate Of The National Physical Therapy Examination, Daniel W. Suckow, C. Jayne Brahler, Betsy Donahoe-Fillmore, Mary Insana Fisher, Philip A. Anloague

Physical Therapy Faculty Publications

Objectives: 1) To investigate the relationships among critical thinking (CT) abilities, overall academic performance in the Doctorate of Physical Therapy (DPT) program as measured by cumulative grade point average (GPA), and National Physical Therapy Examination (NPTE) licensure scores, and 2) To determine if NPTE scores were significantly different between groups of students who were classified as having low, moderate or high CT abilities.

Background: It is well-established that physical therapy practice requires good clinical reasoning skills. Passage of the NPTE is required for licensure. Research to date has been mixed as to whether CT abilities or GPA can predict success …

Comparison Of Transcutaneous Electrical Nerve Stimulation And Cryotherapy For Increasing Quadriceps Activation In Patients With Knee Pathologies, Conrad M. Gabler, Adam S. Lepley, Timothy L. Uhl, Carl G. Mattacola

Physical Therapy Faculty Publications

Proper neuromuscular activation of the quadriceps muscle is essential for maintaining quadriceps strength and lower extremity function. Quadriceps activation failure is a common characteristic observed in patients with knee pathologies, and it is defined as an inability to voluntarily activate the entire alpha motor neuron pool innervating the quadriceps. One of the more popular techniques used to assess quadriceps activation is the superimposed burst (SIB) technique. The SIB technique is a force-based technique which uses a supramaximal, percutaneous electrical stimulation to activate all of the motor units in the quadriceps during a maximal, voluntary isometric contraction of the quadriceps. Central …

Inducible Depletion Of Satellite Cells In Adult, Sedentary Mice Impairs Muscle Regenerative Capacity Without Affecting Sarcopenia, Christopher S. Fry, Jonah D. Lee, Jyothi Mula, Tyler J. Kirby, Janna R. Jackson, Fujun Liu, Lin Yang, Christopher L. Mendias, Esther E. Dupont-Versteegden, John J. Mccarthy, Charlotte A. Peterson

Physical Therapy Faculty Publications

A key determinant of geriatric frailty is sarcopenia, the age-associated loss of skeletal muscle mass and strength. Although the etiology of sarcopenia is unknown, the correlation during aging between the loss of activity of satellite cells, which are endogenous muscle stem cells, and impaired muscle regenerative capacity has led to the hypothesis that the loss of satellite cell activity is also a cause of sarcopenia. We tested this hypothesis in male sedentary mice by experimentally depleting satellite cells in young adult animals to a degree sufficient to impair regeneration throughout the rest of their lives. A detailed analysis of multiple …

Oncology Section Edge Task Force On Prostate Cancer Outcomes: A Systematic Review Of Clinical Measures Of Strength And Muscular Endurance, Mary Insana Fisher, Claire Davies, Genevieve Colon, Hannah Geyer, Lucinda Pfalzer

Physical Therapy Faculty Publications

Background: Strength deficits are a common morbidity following treatment for prostate cancer. Accurate assessment of strength and muscular endurance following prostate cancer treatments is essential to identify deficits and plan rehabilitation.

Purpose: To identify strength and muscular endurance outcome measures that possess strong psychometric properties and are clinically useful for examination of men treated for prostate cancer.

Methods: Multiple electronic databases were searched for articles published after 1995. Studies of tools used to assess strength and muscular endurance were included if they reported psychometric properties, were clinically feasible methods, performed on adults, and published in the English language. Each outcome …

The Effects Of Home-Based Pilates In Healthy College-Age Females, Betsy Donahoe-Fillmore, Mary Insana Fisher, C. Jayne Brahler

Physical Therapy Faculty Publications

Objectives: To quantify and determine the effects of Pilates on core endurance, hamstring flexibility, balance, body composition/mass and perceived stress level in healthy college age females.

Study Design: Randomized controlled trial design.

Background: Emerging research on the Pilates technique is inconclusive regarding benefits to core endurance, flexibility, balance, body mass, and perceived stress.

Methods and Measures: Female college students (n=57; 18-35 years old) were randomly assigned to a Pilates group, who exercised at home with a DVD, or a control group who did not engage in Pilates practice. Core endurance, hamstring flexibility, balance, body composition and stress measurements were taken …

Research Roundup From The Research Committee, Mary Insana Fisher, Shana Harrington

Physical Therapy Faculty Publications

With the expectations of accountability by consumers and third party payors for the efficacy of physical therapy practice, there has been a significant increase in the push to develop outcome measures in rehabilitation. One type of these measures, patient-reported outcome measures (PROs), are becoming increasingly more common in clinical practice. The American Physical Therapy Association’s Guide to Physical Therapist Practice 3rd edition includes outcomes assessment as an integral part of the Patient and Client Management model, and delineates that appropriate tests and measures depend upon established psychometric properties of the measurement.1 The Section on Research formed the Evidence Database to …

Oncology Section Edge Task Force On Breast Cancer Outcomes: A Systematic Review Of Outcome Measures For Functional Mobility, Mary Insana Fisher, Jeannette Lee, Claire Davies, Hannah Geyer, Genevieve Colon, Lucinda Pfalzer

Physical Therapy Faculty Publications

Background: Breast cancer treatments in women with breast cancer often result in physical impairments that lead to activity limitations and participation restrictions. These limitations and restrictions manifest in impaired functional mobility skills that may impact survivorship. Thus, evaluation of functional mobility is an important part of survivorship care.

Purpose: To identify functional mobility outcome measures that possess strong psychometric properties and are clinically useful for examination of women treated for breast cancer.

Methods: Multiple electronic databases were searched for articles published after 1995. Studies were included if they reported psychometric properties, used clinically feasible methods, were performed on adults, and …

Randomized, Placebo-Controlled, Double-Blind Pilot Study Of D-Cycloserine In Chronic Stroke, Andrew Butler, Justiss Kallos, Stephen N. Housley, Michelle Laplaca, Stephen F. Traynelis, Stephen L. Wolf

Physical Therapy Faculty Publications

Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment.N-Methyl-D-aspartate receptors(NMDA-R) have been shown to play a role in synaptic plasticitywhen activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory.We hypothesized thatD-cycloserine,when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (𝑛 = 14) were randomized to Dcycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used …

Research Round-Up: Manual Muscle Testing, Mary Insana Fisher, Shana Harrington

Physical Therapy Faculty Publications

Manual muscle testing was developed in response to the need to assess muscle strength losses during the polio outbreak in early part of the 20th century. The development of this original method is credited to Wilhelmine Wright and Robert W. Lovett, MD. Wright presented this method in 1912 in the Boston Medical Surgical Journal, and Lovett expanded the description of the testing method in 1916 in the Journal of the American Medical Association. The development of quantifying muscle strength by rating force generated against external resistance was an important development in objectifying assessment methods of the time.

Today, manual muscle …

Randomized, Placebo-Controlled, Double-Blind Pilot Study Of D-Cycloserine In Chronic Stroke, Andrew Butler, Justiss Kallos, Stephen N. Housley, Michelle Laplaca, Stephen F. Traynelis, Stephen L. Wolf

Physical Therapy Faculty Publications

Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment. N-Methyl-D-aspartate receptors (NMDA-R) have been shown to play a role in synaptic plasticity when activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory. We hypothesized that D-cycloserine, when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (n=14) were randomized to D-cycloserine plus RAP or placebo plus RAP. Functional, …