Many therapies are emerging that aim to improve motor function in people with stroke. Identifying key biological substrates needed for treatment gains would help to predict treatment effects and to maximize treatment impact. The current study addressed the hypothesis that behavioral gains from therapy targeting distal upper extremity are predicted by the structural integrity of key motor system white matter tracts.

Twenty-three subjects with chronic left-sided stroke underwent robotic therapy targeting the distal right upper extremity. MRI was obtained at baseline and used to outline the infarct. For each subject, the degree to which stroke injured each of 4 descending white matter tracts (from the primary motor cortex, supplementary motor area, dorsal premotor cortex, and ventral premotor cortex, respectively) was determined. Correlations between tract-specific injury and behavioral gains from therapy were then examined.

Numerous examples were found whereby tract-specific injury predicted treatment gains. The strongest correlations pertained to stroke injury to tracts descending from the primary motor cortex and dorsal premotor cortex. Infarct volume and baseline behavior were weak predictors of treatment gains.

Extent of injury to specific motor tracts predicts behavioral gains from treatment in subjects with chronic stroke. This supports a role for these tracts in mediating treatment effects and reinforces the importance of lesion location in stroke. Tract-specific injury was stronger than infarct volume or baseline clinical status at predicting gains, identifies subjects with sufficient biological substrate to improve from therapy, and so might be useful as an entry criterion in repair-based trials.

The COVID-19 pandemic has uniquely impacted US National Park Service (NPS) units. This study seeks to help inform future visitor use management and planning by compiling data from five NPS units (Acadia, Glacier, Grand Teton, Shenandoah, and Yellowstone National Parks), focusing on how the pandemic influenced management and impacted visitor use. Data were collected from both park managers and visitors. Results provide understanding regarding managerial changes, user-capacity limits, and documented changes in visitation in 2020 compared to 2019. These results are coupled with park visitor data from 2020, including visitor demographics, motivations and perceived outcomes, information sources for visiting during the pandemic, potential behavioral shifts in response to COVID-19 while on-site, and intent to visit in the future. The results suggest that the distinct shifts in visitation patterns during 2020 impacted park managers’ ability to predict and efficiently respond to visitor use changes. This issue was exacerbated by staffing shortages attributed to the pandemic. Lessons learned regarding what worked well (e.g., respondents were able to achieve health-related outcomes), and what could be improved (e.g., knowing that visitors adapted behaviors to maintain personal safety, and future staffing allocations can be focused temporally and spatially based on these 2020 use trends) can be incorporated to help prepare park managers, surrounding gateway communities, and state tourism authorities for the future.