Jill Whitall

University of Maryland, Baltimore | UMB · Department of Physical Therapy and Rehabilitation Science

In our tribute to Professor Michael Turvey, we have two parallel goals: 1) to highlight the scientific scope of Turvey’s impact on motor development; and, 2) to expose readers to papers that they may not have read but that might cast new light on age-old questions they confront in their current research on motor development. The paper is divided in...

Objective Health care has increasingly expanded into a hybrid in-person/telehealth model. Patients with a variety of health conditions, including cerebellar ataxia, have received virtual health evaluations; however, it remains unknown whether some outcome measures clinicians utilize in the telehealth setting are reliable and valid. The goal of this...

Objectives To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians’ recommended minimum of 45 min of daily therapy. Design Three-round remote e-Delphi study. Setting National study, based in the UK. Participants Occupational therapists and physiotherapists with experience of...

Objectives To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians’ recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study. Design Focus group study. Setting Stroke services in the South of England....

Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in the aging population. Most falls in older fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why old...

Falls in older adults are leading causes of fatal and non-fatal injuries, negatively impacting quality of life among those in this demographic. Most elderly falls occur due to unrecoverable limb collapse during balance control in the single-limb support (SLS) phase. To understand why older adults are more susceptible to falls than younger adults, w...

Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on quality of life in the aging population. Most falls in elderly fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why older...

Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effecti...

Research Objectives To investigate age-related differences in eccentric neuromuscular control of the knee and its relationship to postural stability during balance recovery following unexpected surface drop perturbations. Design Cross sectional, comparative study. Setting General community. Participants Healthy, community dwelling, and ambulator...

p>Some Western countries, such as England, the Netherlands, Canada, and Australia, have clinical guidelines that provide different time-based recommendations for rehabilitation after stroke. This review seeks to understand the effect of time spent in rehabilitation, to support service providers to optimize recovery for people following stroke. It d...

Introduction Falls are a leading cause of severe injuries and a major threat to quality of life in older adults. Elderly fallers demonstrate insufficient eccentric quadriceps control during the weight acceptance phase of initial single limb stance. However, the functional role of eccentric control of the perturbed (leading) leg during walking balan...

Importance: Few tools are available to assess bimanual deficits after stroke. Objective: To develop the Bimanual Assessment Measure (BAM), which assesses a person's hand coordination in both preferred and prestroke roles (i.e., stabilizer or manipulator). Design: Development and psychometric testing of the BAM. Setting: Research laboratory....

Background Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish real...

Purpose: Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system. Materials an...

Background: Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcom...

In 1981, George Brooks provided a review of the academic discipline of physical education and its emerging subdisciplines. Forty years later, the authors review how the field has changed from the perspective of one subdiscipline, motor development. Brooks’s text sets the scene with four chapters on motor development from leaders in the field, inclu...

Background Stand-to-sit (StandTS) movement is an important functional activity that can be challenging for older adults due to age-related changes in neuromotor control. Although trunk flexion, eccentric contraction of the rectus femoris (RF), and coordination of RF and biceps femoris (BF) muscles are important to the StandTS task, the effects of a...

Interhemispheric interactions are important for arm coordination and hemispheric specialization. Unilateral voluntary static contraction is known to increase bilateral corticospinal motor evoked potential (MEP) amplitude. It is unknown how increasing and decreasing contraction affect the opposite limb. Since dynamic muscle contraction is more ecolo...

Motor development research has had a rich history over the 20th century with a wide array of scientists contributing to a broad and deep body of literature. Just like the process of development, progress within the field has been non-linear, with rapid periods of growth occurring after the publication of key research articles that changed how we co...

In 1989, Clark and Whitall asked the question, “What is motor development?” They were referring to the study of motor development as an academic research enterprise and answered their question primarily by describing four relatively distinct time periods characterized by changes in focus, theories or concepts, and methodology. Their last period was...

In Part I of this series, we looked back at the 20 th century and re-examined the history of Motor Development research described in Clark & Whitall’s 1989 paper “What is Motor Development? The Lessons of History”. We now move to the 21 st century, where the trajectories of developmental research have evolved in focus, branched in scope, and diverg...

We previously demonstrated that lateralization in the neural control of predictive and impedance mechanisms is reflected by interlimb differences in control of bilateral tasks. Aging has been shown to reduce lateralization during unilateral performance, presumably due to greater recruitment of the ipsilateral hemisphere. We now hypothesize that agi...

Objective To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive tas...

Background. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound. Objective. To investigate the efficacy of robot-assisted therapy combined w...

Objective: The now standard cortical stimulation approach of inhibiting contralesional primary motor cortex (cM1) disrupts bimanual coordination while facilitating ipsilesional M1 (iM1) fails to enhance paretic arm function, in severely impaired individuals. We propose an alternative target, enhancing contralesional dorsal premotor cortex (cPMd) to...

In this chapter, we ask two questions. First, can the study of the perception–action system across time offer a useful model for understanding motor development? Second, can the study of the perception–action system in children with developmental coordination disorder (DCD) inform our understanding of atypical as well as typical motor development?...

p>In this chapter, we ask two questions. First, can the study of the perception–action system across time offer a useful model for understanding motor development? Second, can the study of the perception–action system in children with developmental coordination disorder (DCD) inform our understanding of atypical as well as typical motor development...

Coordinating bimanual movements is essential for everyday activities. Two common types of bimanual tasks are common goal, where two arms share a united goal, and dual goal, which involves independent goals for each arm. Here, we examine how the neural control mechanisms differ between these two types of bimanual tasks. Ten non-disabled individuals...

Two contrasting views of handedness can be described as 1) complementary dominance, in which each hemisphere is specialized for different aspects of motor control, and 2) global dominance, in which the hemisphere contralateral to the dominant arm is specialized for all aspects of motor control. The present study sought to determine which motor late...

Purpose: To investigate the effectiveness and feasibility of Kinect-based upper extremity rehabilitation on functional performance in chronic stroke survivors. Methods: This was a single cohort pre-post test study. Participants (N=10; mean age = 62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks in a university...

Using non-invasive brain stimulation (NIBS) as an adjunctive therapy has become increasingly popular in stroke rehabilitation. Current protocols have focused on the interhemispheric competition model which emphasizes facilitation of the lesioned hemisphere or inhibition of the non-lesioned hemisphere. Few studies have examined the effects of NIBS o...

Background: Locomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative. Furthermore, previous studies have suggested that adaptation context may a...

Timing control, such as producing movements at a given rate or synchronizing movements to an external event, has been studied through a finger-tapping task where timing is measured at the initial contact between finger and tapping surface or the point when a key is pressed. However, the point of peak force is after the time registered at the tappin...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: • To establish if greater time spent in rehabilitation results in greater improvement in measures of activity than less time spent in rehabilitation. • To assess the effect of total time spent (in minutes) in rehabilitation on activity/activity limitations follo...

Background: Estimates of the prevalence of developmental coordination disorder range from 1.7% to 19%, raising concerns about the discriminative ability of the Movement Assessment Battery for Children (MABC). Aims: We compared MABC performance of children from the United States and Brazil aged 4–12 years. We aimed to examine: a) the prevalence of...

Both children and adults can learn motor sequences quickly in one learning session, yet little is known about potential age-related processes that underlie this fast sequence acquisition. Here, we examined the progressive performance changes in a one-session modified serial reaction time task in 6- and 10-year-old children and adults. We found that...

Background and Purpose: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavior...

Objective: To investigate the effects of gait training with body weight support on a treadmill vs. overground in individuals with chronic stroke. Design: Randomized controlled trial. Setting: University research laboratory PARTICIPANTS: Twenty-eight individuals with chronic stroke (> 6 months). Interventions: Participants were randomly assig...

The low-cost virtual reality system such as Microsoft Kinect has become an increasingly popular tool for continued stroke rehabilitation outside of traditional rehabilitation . Despite it’s popularity, the usability, therapeutic methods and participants’ perspective towards use of computer-based training such as the Kinect system remains largely un...

The low-cost virtual reality system such as Microsoft Kinect has become an increasingly popular tool for continued stroke rehabilitation outside of traditional rehabilitation . Despite it’s popularity, the usability, therapeutic methods and participants’ perspective towards use of computer-based training such as the Kinect system remains largely un...

After stroke, the ability to perform two tasks concurrently is diminished, which may contribute to less pronounced gains on activity level after rehabilitation. The current study investigated whether upper extremity dual-task performance is compromised after stroke, as a first step towards examining whether cortical stimulation can reduce dual-task...

Although evidence exists that changes in sensorimotor function occur with aging, changes in the bilateral coordination of the upper extremities are less understood. Here, we review the behavioral and neural evidence of declines in bilateral coordination as well as the implications these deficits have on function and physical rehabilitation. We begi...

Objective: To quantitatively define levels of upper extremity movement impairment using cluster analysis of Fugl-Meyer upper extremity (FM-UE) with and without reflex items. Design: Secondary analysis of FM-UE individual item scores compiled from baseline testing of 5 studies with consistent testing procedures. Setting: University and VA resea...

Although evidence exists that changes in sensorimotor function occur with aging, changes in the bilateral coordination of the upper extremities are less understood. Here, we review the behavioral and neural evidence of declines in bilateral coordination as well as the implications these deficits have on function and physical rehabilitation. We begi...

Reaching toward an object usually consists of a sequence of elemental actions. Using a reaching task sequence, the authors investigated how task elements of that sequence affected feedforward and feedback components of the reaching phase of the movement. Nine right-handed adults performed, with their dominant and nondominant hands, 4 tasks of diffe...

In this commentary, we note the lack of using a dynamic systems perspective on the study of developmental coordination disorder even though the former has been used for the study of motor development. We suggest re-considering this approach partly because it addresses both development and coordination under a unified framework. Specifically, we des...

Challenges in bimanual function can be found above and beyond unimanual deficits after stroke and can lead to role reversals of both hands. In these cases, the previously dominant hand acts as a stabilizer rather than manipulator and vice versa for the non-dominant hand. Despite the emerging understanding of bimanual impairments and rehabilitation,...

Robots designed for rehabilitation of the upper extremity after stroke facilitate high rates of repetition during practice of movements and record precise kinematic data, providing a method to investigate motor recovery profiles over time. OBJECTIVE: To determine how motor recovery profiles during robotic interventions provide insight into improvi...

Figure 1: Global and local coordinate system set up Figure 2: Mean joint moments of shoulder, elbow and wrist of non-disabled subjects (n=3). Positive direction (+): E (Extension), Ad (Adduction), ER (External Rotation); Negative direction (-): F (Flexion), Ab (Abduction), IR (internal Rotation). Profiles are the average of three trials for the thr...

Individuals following stroke have exhibited various degrees of deficits in both paretic and non-paretic arms. Nevertheless, the majority of activities of daily living require collaboration between the arms. Some tasks involve a common-goal in which two arms sharing a single focus, such as pulling out a drawer with both arms. Others involve similar...

Date Presented 4/16/2015 Poststroke rehab has turned toward treatment of bimanual coordination. However, there is no comprehensive measure of bimanual function. The Bimanual Assessment Measure (BAM) will be the first comprehensive measure of bimanual functioning, and it has good content validity based on input from individuals with stroke and occup...

In this paper, I argue that physical activity in the form of exercise provides wonderful health benefits for individuals with chronic stroke but fails to also reduce the wider effects of disability for these individuals. The argument proceeds first with a definition of terms, including the classification framework of health and disability according...

Background Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally...

The consequences of developmental co-ordination disorder (DCD) indicate a need for identification in order to provide adequate intervention. The goals of the study were to investigate DCD prevalence across age bands, gender, race and school performance; the motor difficulties of children with DCD, at-risk and typically developing children in the Mo...

Objective: Stroke is the leading cause of long-term disability worldwide with approximately 75% of stroke survivors reporting functional upper extremity dysfunction. Many activities of daily living (ADL’s) comprise upper extremity (UE) tasks involving varying degrees of collaboration between the two arms/hands. Some tasks involve a common goal in w...

A person's step length and rate may be measured, for example, through sensors that collect spatial and temporal gait parameter data. The measurements are then used to determine the rate of a rhythmic auditory cue to improve the person's gait. For example, a system links sensors to detect step rate and length to an audio cue provided to headphones,...

One target for rehabilitating locomotor disorders in older adults is to increase mobility by improving walking velocity. Combining rhythmic auditory cueing (RAC) and treadmill training permits the study of the stride length/stride velocity ratio (SL/SV), often reduced in those with mobility deficits. We investigated the use of RAC to increase veloc...

Purpose: Our purpose was to use cluster analyses of temporal and spatial kinematic variables to define movement signatures for forward unilateral reaching and compare clusters before and after upper extremity training in participants status post stroke. We hypothesized that this analysis could provide a means to demonstrate changes after training....

Unilateral tapping studies have shown that adults adjust to both perceptible and subliminal changes in phase or frequency. This study focuses on the phase responses to abrupt/perceptible and gradual/subliminal changes in auditory-motor relations during alternating bilateral tapping. We investigated these responses in participants with and without g...

Determine whether adaptation to a swing phase perturbation during gait transferred from treadmill to overground walking, the rate of overground deadaptation, and whether overground aftereffects improved step length asymmetry in persons with hemiparetic stroke and gait asymmetry. Ten participants with stroke and hemiparesis and 10 controls walked ov...

Asymmetries in dynamic balance stability have been previously observed. The goal of this study was to determine whether leg preference influenced the stepping response to a waist-pull perturbation in older adult fallers and non-fallers. 39 healthy, community-dwelling, older adult (>65years) volunteers participated. Participants were grouped into no...

The answer to the question is yes, with a few exceptions. Defining and providing our rationale for this answer is the purpose of this article. Our position derives from our 15-year research program of combining a rhythmic auditory cue to a bilateral training approach for individuals with upper extremity hemiparesis. We begin with describing how we...

Functional arm reaching involves multilinked joints: shoulder, elbow, and wrist. We propose that induced position analysis is a useful analytical tool for multijoint coordination of arm reaching. This method was used to compute the contributions of the net joint moment to the hand position when reaching forward. We describe the method and give exam...

After stroke, movement patterns of the upper limb (UL) during functional arm reaching change to accommodate altered constraints. These compensatory movement control strategies do not, however, have a one-to-one mapping with posttraining outcomes. In this study, we quantify arm movement control strategies in unilateral and bilateral reaching tasks u...

Background: Persons with stroke and hemiparesis walk with a characteristic pattern of spatial and temporal asymmetry that is resistant to most traditional interventions. It was recently shown in nondisabled persons that the degree of walking symmetry can be readily altered via locomotor adaptation. However, it is unclear whether stroke-related bra...

To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes. Randomized controlled tria...

In two experiments, the ability to use multisensory information (haptic information, provided by lightly touching a stationary surface, and vision) for quiet standing was examined in typically developing (TD) children, adults, and in seven-year-old children with Developmental Coordination Disorder (DCD). Four sensory conditions (no touch/no vision,...

Children with Developmental Coordination Disorder (DCD) are more variable in timing their fingers to an external cue. In this study, we investigated the intrinsic coordination properties of self-selected anti-phase finger tapping with and without vision and audition in children with and without DCD and compared their performance to that of adults....

This randomized controlled trial tests the efficacy of bilateral arm training with rhythmic auditory cueing (BATRAC) versus dose-matched therapeutic exercises (DMTEs) on upper-extremity (UE) function in stroke survivors and uses functional magnetic resonance imaging (fMRI) to examine effects on cortical reorganization. A total of 111 adults with ch...

Stroke survivors with motor deficits often have pyramidal tract atrophy caused by degeneration of corticospinal fibers. The authors hypothesized that the degree of atrophy correlates with severity of motor impairment in patients with chronic stroke and predicts the response to rehabilitation training. They performed a post hoc analysis of 42 hemipa...