The heat is on: Investigating the effect of psychological pressure on competitive performance in elite surfing

Competitive sport often creates a high-stake and thus a high-pressure environment for its athletes. In the past, research has pointed to the negative effect that competitive pressure might have on skills and movement executions that have been perfected through prior practice. The Attentional Control Theory: Sport (ACTS) suggests that specifically high situational pressure and prior performance failures may negatively affect an athlete's subsequent performance. This study aimed to investigate the influence of situational pressure and previous performance errors on performance (i.e., wave score) in elite surfing while considering various contextual factors. A total of 6497 actions, performed by 80 elite surfers (female n = 28; male n = 52), were annotated based on video recordings of the 2019 World Championship Tour (WCT). A multi-level model was used to analyse the effect of pressure, previous errors and other contextual factors on the wave scores of individual surfers (i.e., events were nested within athletes). Partially confirming previous research, prior errors caused a significant decrease in surfing performance on the following ride. However, neither a significant effect of situational pressure on performance nor inter-individual differences in how prior-errors and situational pressure affected performance were found.

Technical skills in complex tennis situations: Dutch talented players U15 compared to players U17

Introduction

Technical skills in complex situations appear crucial for progress towards elite tennis performance. However, it is unknown how these skills develop in different age categories in a group of talented youth players. The aim of this study is to evaluate possible differences in technical skills among Dutch talented youth tennis players U15 compared to U17.

Methods

A total of 19 players (12 males, 7 females; age 14.6 ± 1.4 years) were tested on ball speed, accuracy, percentage errors and spin rate using the on-court Dutch Technical-Tactical Tennis Test. With a ball machine, four games were simulated which were either fixed (game 1 and game 2) or variable (game 3 and game 4), depending on the complexity of the task. Each game consisted of two offensive, two neutral and two defensive rallies, representing different tactical situations.

Results

A two-way ANOVA revealed a statistically significant interaction between the effects of age category and sex for ball speed (F(1,15) = 5.472, p = 0.034, η ² = 0.267), indicating that males U17 produced higher ball speed compared to males U15, whereas no differences were found between females U15 and U17. A one-way ANCOVA showed that, regardless of sex, players U17 scored significantly higher on accuracy than players U15 (F(1,16) = 5.021, p = 0.040, η ² = 0.239). No differences were found between players U15 and U17 for spin rate and percentage errors (p > .05), although there was a medium to large effect size for males U17 to produce higher spin rates compared to males U15. A closer examination of accuracy revealed that players U17 scored significantly higher compared to players U15 in game 4 (F(1,17) = 6.358, p = .022, η ² = .272) and in defensive situations (F(1,17) = 9.602, p = .007, η ² = .361).

Discussion

In conclusion, the results of the current study suggest that technical skills, especially ball speed for males and accuracy in complex situations for both males and females, continue to develop in adolescence in talented tennis players. There is an increased understanding about underlying technical skills that contribute to progress towards elite tennis performance. To effectively develop technical skills, coaches are encouraged to design specific practices where these skills are performed in complex situations under high cognitive and temporal pressure.

Self-assessed tactical skills in tennis players: Psychometric evaluation of the Tactical Skills Questionnaire in Tennis

To our knowledge, no feasible, valid and reliable instrument exists to examine tactical skills over the course of multiple training and game situations in tennis yet. Therefore, the aim of this study was to develop and evaluate the psychometric properties of the Tactical Skills Questionnaire in Tennis (TSQT). The TSQT is a new instrument with closed-ended questions designed to examine tactical skills in tennis players. Participants were 233 competitive tennis players (age: 17.06 ± 4.74 years) competing on national or regional levels. With a principal component analysis (PCA) we identified four theoretically meaningful subscales for the 31-item TSQT: “Anticipation and positioning,” “Game intelligence and adaptability,” “Decision-making,” and “Recognizing game situations” and confirmed them with a confirmatory factor analysis (CFA) (χ² = 527.02, df = 426, p < 0.001, CFI = 0.93, RMSEA = 0.045, SRMR = 0.079). Internal consistency was good, with Cronbach's alpha of 0.89 for the entire scale and McDonald's omega ranging from 0.69 to 0.78 for the separate subscales. A subsample of 57 players completed the TSQT twice to assess test-retest reliability. Absolute test-retest reliability of the subscales was good with no significant differences in mean scores between test and retest (p > 0.05). Relative test-retest reliability was moderate with ICC values ranging from 0.65 to 0.71. National players outperformed regional players on the subscales “Game intelligence and adaptability,” “Decision-making,” and “Recognizing game situations” (p < 0.05), and there was a trend toward significance for “Anticipation and positioning” (p = 0.07). This study supported the psychometric properties of the TSQT. Evaluating tactical skills with the TSQT provides players, coaches and other professionals with insight in players' self-assessed tactical skills over the course of multiple training and game situations. It creates the opportunity for players to reflect on their skills and detect personal development areas with their coach. We advise to use this information as input for tailor-made training programs.

Recognizing differentiating clinical signs of CLN3 disease (Batten disease) at presentation

Purpose

To help differentiate CLN3 (Batten) disease, a devastating childhood metabolic disorder, from the similarly presenting early‐onset Stargardt disease (STGD1). Early clinical identification of children with CLN3 disease is essential for adequate referral, counselling and rehabilitation.

Methods

Medical chart review of 38 children who were referred to a specialized ophthalmological centre because of rapid vision loss. The patients were subsequently diagnosed with either CLN3 disease (18 patients) or early‐onset STGD1 (20 patients).

Results

Both children who were later diagnosed with CLN3 disease, as children who were later diagnosed with early‐onset STGD1, initially presented with visual acuity (VA) loss due to macular dystrophy at 5–10 years of age. VA in CLN3 disease decreased significantly faster than in STGD1 (p = 0.01). Colour vision was often already severely affected in CLN3 disease while unaffected or only mildly affected in STGD1. Optic disc pallor on fundoscopy and an abnormal nerve fibre layer on optical coherence tomography were common in CLN3 disease compared to generally unaffected in STGD1. In CLN3 disease, dark‐adapted (DA) full‐field electroretinogram (ERG) responses were either absent or electronegative. In early‐onset STGD1, DA ERG responses were generally unaffected. None of the STGD1 patients had an electronegative ERG.

Conclusion

Already upon presentation at the ophthalmologist, the retina in CLN3 disease is more extensively and more severely affected compared to the retina in early‐onset STGD1. This results in more rapid VA loss, severe colour vision abnormalities and abnormal DA ERG responses as the main differentiating early clinical features of CLN3 disease.

The value of technical characteristics for future performance in youth tennis players: A prospective study

The aim of this study is to examine whether technical characteristics predict current and future tennis performance of youth tennis players. Twenty-nine male youth tennis players (age 13.40 ± .51) were assessed on anthropometrical characteristics (height, weight, maturity status) and technical characteristics (ball speed, accuracy and percentage errors) using an on-court tennis test when they were under-14 (U14). Game situations were simulated, which were either fixed or variable. The variable game situations required players to consider the direction of the ball, as opposed to the fixed game situations where players needed to play every ball to the same side. Players’ tennis ratings were obtained U14 (‘current performance’) and under-18 (U18) (‘future performance’). According to their rating U18 players were classified as future elite (n = 9) or future competitive (n = 20). A multiple linear regression analysis showed that ball speed and accuracy were significant predictors of current and future performance (p < .001), with R² of .595 and .463, respectively. When controlling for age, a one-way MANCOVA revealed that future elite players were more accurate than future competitive players (p = .048, 95% CI [.000 to .489]), especially in variable compared to fixed game situations (p < .05). In conclusion, the current study is the first to show that technical characteristics are crucial for current as well as future performance in youth male tennis players. Findings of this prospective study provide essential information to coaches about characteristics that require most attention in performance development in youth players.

Longitudinal development of 5m sprint performance in young female tennis players

Sprint performance over short distances is a central component in young tennis players' development. This study aimed to examine the longitudinal development of sprint performance in young female tennis players, and to investigate differences between performance levels. Also potentially explanatory variables were investigated. Female tennis players aged 10-15 (N = 167) participated in a, mixed-longitudinal study (n = 48 elite; n = 119 sub-elite). Players were measured annually on the 5 m sprint as well as for possible explaining variables for 5 m sprint performance development (age, height, body mass, maturity status, lower limb explosive strength). Multilevel analysis was used to obtain a developmental model. Moreover, it was possible to predict sprint performance (5 m) based on chronological age, body size given by height, and lower limb strength performance (p < .05). Significant different developmental patterns were found for elite and sub-elite players, with elite players aged 10-14 being faster. After age 14, no significant differences were found in sprint performance between elite and sub-elite players (p > . 05). Sprint performance is an important characteristic of young female tennis players and seemed to depend on growth and maturation in parallel to physical fitness.

Technical and tactical skills related to performance levels in tennis: A systematic review

The aim of this systematic review is to provide an overview of outcome measures and instruments identified in the literature for examining technical and tactical skills in tennis related to performance levels. Such instruments can be used to identify talent or the specific skill development training needs of particular players. Searches for this review were conducted using the PubMed, Web of Science, and PsycInfo databases. Out of 733 publications identified through these searches, 40 articles were considered relevant and included in this study. They were divided into three categories: (1) technical skills, (2) tactical skills and (3) integrated technical and tactical skills. There was strong evidence that technical skills (ball velocity and to a lesser extent ball accuracy) and tactical skills (decision making, anticipation, tactical knowledge and visual search strategies) differed among players according to their performance levels. However, integrated measurement of these skills is required, because winning a point largely hinges on a tactical decision to perform a particular stroke (i.e., technical execution). Therefore, future research should focus on examining the relationship between these skills and tennis performance and on the development of integrated methods for measuring these skills.

Trajectories of cardiorespiratory fitness in patients with juvenile dermatomyositis

Objectives

Previous research demonstrated decreased cardiorespiratory fitness (CRF) in patients with JDM during active disease and remission. However, longitudinal data regarding trajectories of CRF are currently lacking. The objective of this study was to determine trajectories of CRF in patients with both monocyclic and chronic JDM, and to identify potential predictors of these trajectories.

Methods

Thirty-six patients with JDM [median age (interquartile range) at diagnosis: 8.3 (6.3-15.4) years] treated in our paediatric rheumatology outpatient clinic were included. All patients performed multiple cardiopulmonary exercise tests between 2003 and 2016. Relevant CRF parameters were analysed, including peak oxygen uptake, maximal workload, mechanical efficacy and oxygen uptake at ventilatory anaerobic threshold. We analysed trajectories up to 10 years after diagnosis and determined predictors of CRF outcome parameters by multilevel analyses.

Results

Trajectories demonstrated significant declines in CRF during the active phase of the disease with subsequent improvement in CRF during the initial years after diagnosis. However, hereafter no further improvements, and even a decrease, in CRF were observed over time in both monocyclic and chronic subtypes of JDM. We found that a longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF.

Conclusion

Patients with both monocyclic and chronic JDM show decreases in long-term CRF trajectories. Longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF. This study stresses the need for regular evaluation of CRF and implementation of (exercise) interventions to improve CRF in patients with JDM, even in monocyclic patients.

Prediction of Tennis Performance in Junior Elite Tennis Players

Predicting current and future tennis performance can lead to improving the development of junior tennis players. The aim of this study is to investigate whether age, maturation, or physical fitness in junior elite tennis players in U13 can explain current and future tennis performance. The value of current tennis performance for future tennis performance is also investigated. A total of 86 junior elite tennis players (boys, n = 44; girls, n = 42) U13 (aged: 12.5 ± 0.3 years), and followed to U16, took part in this study. All players were top-30 ranked on the Dutch national ranking list at U13, and top-50 at U16. Age, maturation, and physical fitness, were measured at U13. A principal component analysis was used to extract four physical components from eight tests (medicine ball throwing overhead and reverse, ball throwing, SJ, CMJas, Sprint 5 and 10 meter, and the spider test). The possible relationship of age, maturation, and the physical components; "upper body power", "lower body power", "speed", and "agility" with tennis performance at U13 and U16 was analyzed. Tennis performance was measured by using the ranking position on the Dutch national ranking list at U13 and U16. Regression analyses were conducted based on correlations between variables and tennis performance for boys and girls, separately. In boys U13, positive correlations were found between upper body power and tennis performance (R² is 25%). In girls, positive correlations between maturation and lower body power with tennis performance were found at U13. Early maturing players were associated with a better tennis performance (R² is 15%). In girls U16, only maturation correlated with tennis performance (R² is 13%); later-maturing girls at U13 had better tennis performances at U16. Measuring junior elite tennis players at U13 is important for monitoring their development. These measurements did not predict future tennis performance of junior elite tennis players three years later. Future research should focus on other aspects in order to predict tennis performance better.

Laterality related to the successive selection of Dutch national youth soccer players

In the general population, estimates of left-foot preference are around 20%. In soccer, specific tasks create positional demands, requiring 40% of the players to be left-footed. Whether and how this is related to the selection of players is unknown. To examine the successive selection of soccer players for Dutch national youth teams in relation to foot preference, 280 youth players (age = 16.2 ± 1.08 years) were monitored from the U16 through the U19 teams over the last 5 years. No difference in successive selection between left- and right-footed players was found (p < 0.05). Regardless of foot preference, more than 50% of the selected players were deselected out of a national youth team after 2 years. On average, 31% of the national youth players were left-footed, which is higher than expected, based on population estimates (χ² (1) = 37.49, p < 0.001, w = 0.27). However, there was an under-representation of left-footed players, based on expected positional demands (i.e., attack, midfield, defence) (χ² (1) = 16.83, p < 0.001, w = 0.18). The conclusion is that left-foot preference increases the probability of selection in Dutch national youth soccer teams.

Modeling Longitudinal Changes in 5 m Sprinting Performance Among Young Male Tennis Players

Year-to-year changes in sprinting in youth tennis players were examined in a mixed-longitudinal study (256 male players, aged 10–15 years: 993 measurements). Height (h), body mass (BM), lower limb explosive strength (LLES), and a 5-m sprint were measured over five years. During that period, players were classified as elite or sub-elite. To account for the repeated measurements within the individual nature of longitudinal data, multilevel random effects regression analyses were used. Sprint performance improved with age at each additional 1 year of age, thus predicting ∼.016 sec improvement in five-meter sprint time by all variables of the model. It was possible to predict the performance of elite tennis players in the 5-m sprint (sec) for elite players (1.1493 – (0.0159 ċ centered age) – (0.009 ċ BM) – (0.044 ċ LLES) and sub-elite players (1.1493 – (0.0159 ċ centered age) + 0.0135 – (0.009 ċ BM) – (0.044 ċ LLES) – (0.0557 ċ centered age). Sprint performance differences between elite and sub-elite players was related to longitudinal changes in body size and lower limb strength up until age 13.

Cognitive Functions in Elite and Sub-Elite Youth Soccer Players Aged 13 to 17 Years

Soccer players are required to anticipate and react continuously in a changing, relatively unpredictable situation in the field. Cognitive functions might be important to be successful in soccer. The current study investigated the relationship between cognitive functions and performance level in elite and sub-elite youth soccer players aged 13–17 years. A total of 47 elite youth soccer players (mean age 15.5 years, SD = 0.9) and 41 sub-elite youth soccer players (mean age 15.2 years, SD = 1.2) performed tasks for “higher-level” cognitive functions measuring working memory (i.e., Visual Memory Span), inhibitory control (i.e., Stop-Signal Task), cognitive flexibility (i.e., Trail Making Test), and metacognition (i.e., Delis-Kaplan Executive Function System Design Fluency Test). “Lower-level” cognitive processes, i.e., reaction time and visuo-perceptual abilities, were also measured with the previous tasks. ANOVA’s showed that elite players outscored sub-elite players at the “higher-level” cognitive tasks only, especially on metacognition (p < .05). Using stepwise discriminant analysis, 62.5% of subjects was correctly assigned to one of the groups based on their metacognition, inhibitory control and cognitive flexibility performance. Controlling for training hours and academic level, MANCOVA’s showed differences in favor of the elite youth soccer players on inhibitory control (p = .001), and cognitive flexibility (p = .042), but not on metacognition (p = .27). No differences were found concerning working memory nor the “lower-level” cognitive processes (p > .05). In conclusion, elite youth soccer players have better inhibitory control, cognitive flexibility, and especially metacognition than their sub-elite counterparts. However, when training hours are taken into account, differences between elite and sub-elite youth soccer players remain apparent on inhibitory control and cognitive flexibility in contrast to metacognition. This highlights the need for longitudinal studies to further investigate the importance of “higher-level” cognitive functions for talent identification, talent development and performance in soccer.

The Effect of Stress and Recovery on Field-test Performance in Floorball

Physical and psychosocial stress and recovery are important performance determinants. A holistic approach that monitors these performance determinants over a longer period of time is lacking. Therefore this study aims to investigate the effect of a player's physical and psychosocial stress and recovery on field-test performance. In a prospective non-experimental cohort design 10 female Dutch floorball players were monitored over 6 months. To monitor physical and psychosocial stress and recovery, daily training-logs and 3-weekly the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) were filled out respectively. To determine field-test performance 6 Heart rate Interval Monitoring System (HIMS) and 4 Repeated Modified Agility T-test (RMAT) measurements were performed. Multilevel prediction models were applied to account for within-players and between-players field-test performance changes. The results show that more psychosocial stress and less psychosocial recovery over 3-6 weeks before testing decrease HIMS performance (p≤0.05). More physical stress over 6 weeks before testing improves RMAT performance (p≤0.05). In conclusion, physical and psychosocial stress and recovery affect submaximal interval-based running performance and agility up to 6 weeks before testing. Therefore both physical and psychosocial stress and recovery should be monitored in daily routines to optimize performance.

A longitudinal study on gross motor development in children with learning disorders

This longitudinal study examined the development of gross motor skills, and sex-differences therein, in 7- to 11-years-old children with learning disorders (LD) and compared the results with typically developing children to determine the performance level of children with LD. In children with LD (n=56; 39 boys, 17 girls), gross motor skills were assessed with the Test of Gross Motor Development-2 and measured annually during a 3-year period. Motor scores of 253 typically developing children (125 boys, 112 girls) were collected for references values. The multilevel analyses showed that the ball skills of children with LD improved with age (p<.001), especially between 7 and 9 years, but the locomotor skills did not (p=.50). Boys had higher ball skill scores than girls (p=.002) and these differences were constant over time. Typically developing children outperformed the children with LD on the locomotor skills and ball skills at all ages, except the locomotor skills at age 7. Children with LD develop their ball skills later in the primary school-period compared to typically developing peers. However, 11 year-old children with LD had a lag in locomotor skills and ball skills of at least four and three years, respectively, compared to their peers.

Soccer skill development in talented players

The aim of the study was to gain insight into the development of soccer-specific skills and whether differences between talented players exist on the Loughborough Soccer Passing Test (LSPT). Two scores were derived from the LSPT: 1) execution time: time to complete 16 passes (speed) and 2) skill performance time: execution time including bonus and penalty time for accuracy. The study consisted of 2 parts, the first of which incorporated a quasi-longitudinal design with 270 talented players aged 10-18 years performing the LSPT (661 measurement occasions); multilevel modelling was applied. Secondly, differences between those players allowed to continue in the development program (selected, n=269) and players who were forced to leave (de-selected, n=50) were investigated using independent sample t-tests. The longitudinal data showed that the predicted execution time (i. e., speed) improved approximately 18% from age 10-18 years (P<0.05), skill performance time (i. e., combination of speed and accuracy) was predicted to improve approximately 32% (P<0.05). The second part showed that selected players outscored de-selected players only on skill performance time (P<0.05), not on execution time (P>0.05). In conclusion, in high-level youth soccer, the combination of speed and accuracy in soccer skills might be more important than speed alone.

The changing characteristics of talented soccer players--a decade of work in Groningen

Talent development programmes for professional soccer clubs aim to guide players towards professional level performance. We identify whether the intermittent endurance capacity of these players may have changed over time. Since the 2000/2001 competition season, the intermittent endurance capacity of players in the talent development programmes of two professional soccer clubs was measured annually. A total of 492 players participated, divided across seven age categories (under 13 (U13), U14, U15, U16, U17, U18, U19) and resulting in 953 measurements. Analyses of variance showed an improvement in intermittent endurance capacity from the 2000/2001 season to 2009/2010 of around 50% in all age groups (P < 0.05). A possible explanation is the increased quantity and quality of training over the years. When identifying, developing and selecting young players, scouts, trainers and coaches have to be aware that the current level of soccer and its underlying performance characteristics--such as intermittent endurance capacity--are improving over time. This factor may have consequences for current young players aiming to make it to the top 10 years from now.

Multidimensional performance characteristics in selected and deselected talented soccer players

The present study examined whether performance characteristics discriminated between selected and deselected players in talent development programmes. This examination was carried out in talented soccer players, aged 16-18 years using objective measurement instruments. Four domains of multidimensional performance characteristics (physiological, technical, tactical and psychological) were assessed by using a test battery consisting of soccer-specific field tests and questionnaires. Multivariate analyses of covariance revealed that the physiological characteristics peak and repeated shuttle sprint, the technical characteristics of peak and repeated shuttle dribble and the tactical characteristic of 'positioning and deciding', significantly differed between the selected (n=76) and deselected players (n=37), with selected players performing better (P<0.05). Discriminant function analysis showed that the combination of the technical characteristic 'peak dribbling', the tactical characteristic 'positioning and deciding' and the physiological characteristic of 'peak sprinting' classified 69% of talented players correctly. In conclusion, the decisions made by the investigated clubs to either select or deselect players in their talent development programme, whom were aged 16-18 years, were mostly discriminated by aspects of the players' technical, tactical and physiological skill performances. Sports research can play an essential role in investigating the club's perception of important performance characteristics in talented players.

Modelling developmental changes in repeated-sprint ability by chronological and skeletal ages in young soccer players

This study investigated the influence of chronological (CA) and skeletal ages (SA), anthropometry, aerobic endurance and lower limb explosive strength on developmental changes in repeated-sprint ability (RSA) in soccer players aged 11-17 years. Participants were annually followed over 5 years, resulting in 366 measurements. Multilevel regression modelling analysed longitudinal data aligned by CA and SA (Model 1 and 2, respectively). After diagnosing for multicollinearity, it was possible to predict RSA with 2-level hierarchical models [Model 1 (CA as Level 2 predictor): Log-Likelihood=1,515.29, p<0.01; Model 2 (SA as Level 2 predictor): Log-Likelihood=1,513.89, p<0.01]. Estimating sum of sprints for young soccer players are given by equations: sum of sprints=84.47 - 1.82 × CA + 0.03 × CA2 - 0.05 × aerobic endurance - 0.10 × lower limb explosive strength -0.09 × fat-free mass + 0.13 × fat mass (Model 1); 73.58 - 0.43 × SA - 0.05 × aerobic endurance - 0.10 × lower limb explosive strength - 0.08 × fat-free mass - 0.45 × training experience + 0.13 × fat mass (Model 2). The models produced performance curves that may be used to estimate individual performance across adolescent years. Finally, the validity of each model was confirmed based on corresponding measurements taken on an independent cross-sectional sample.

Development of dribbling in talented youth soccer players aged 12-19 years: a longitudinal study

The aims of the current study were to assess the development and determine the underlying mechanisms of sprinting and dribbling needed to compete at the highest level in youth soccer. Talented soccer players aged 12-19 years (n = 267) were measured on a yearly basis in a longitudinal study over 7 years, resulting in 519 measurements. Two field tests, the Shuttle Sprint and Dribble Test and the Slalom Sprint and Dribble Test, were assessed. Anthropometric characteristics, years of soccer experience, and duration of practice were recorded. The longitudinal data were analysed with multi-level modelling. Comparing the two tests at baseline, low correlations were observed (sprinting: r = 0.49; dribbling: r = 0.22), indicating that each test measures distinct qualities (acceleration vs. agility). Low-to-moderate correlations were found between dribbling and sprinting within each test (Shuttle Sprint and Dribble Test: r = 0.54; Slalom Sprint and Dribble Test: r = 0.38). Both dribbling and sprinting improved with age, especially from ages 12 to 14, but the tempo of development was different. From ages 14 to 16, sprinting improved rapidly in contrast to dribbling; this was especially evident on the Slalom Sprint and Dribble Test. In contrast, after age 16 dribbling improved considerably but sprinting hardly improved. Besides age, the factors that contribute to dribbling performance are lean body mass, hours of practice, and playing position.

Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis

We conducted a randomized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/hand function (the Home Care Activity Desk [HCAD] training) in a home setting. Usual care was compared to HCAD training. The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) with respect to their arm/hand function. Eighty-one patients with affected arm/hand function resulting from either stroke, MS or TBI were recruited in Italy, Spain and Belgium; 11 were lost during follow-up (14%). The outcome measures were the Action Research Arm Test (ARAT) and the Nine Hole Peg Test (NHPT). There were no significant differences between the two groups on the outcome measures (ARAT and NHPT); in both groups, patients maintained or even improved their arm/hand function. The HCAD training was found to be as feasible as usual care in terms of clinical outcomes, and both therapists and patients were satisfied with the HCAD intervention. A telerehabilitation intervention using HCAD may increase the efficiency of care.