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Egyptian Rheumatology and Rehabilitation
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Central neuroplasticity and functional outcome of swinging upper limbs following repetitive locomotor training of lower limbs in stroke patients

Egyptian Rheumatology and Rehabilitation volume 41, pages 14–19 (2014)Cite this article

Abstract

Aims

The aim of the study was to investigate the effect of long-term repetitive locomotor training on a treadmill with partial body weight support (TTPBWS) on motor performance of the swinging and supported paretic upper limb and to explore the neurophysiological mechanism underlying this improvement.

Materials and Methods

Thirty ambulatory chronic hemiparetic stroke patients were assigned randomly to either one of two experimental conditions while being trained for 20 min on a treadmill with PBWS 6 days a week for 8 weeks. Patients under condition 1 received verbal cueing to perform bilateral upper limb swinging. In condition 2, patients were instructed to support both upper limbs by holding the treadmill handrails. Fugel-Meyer upper extremity motor performance test (FMUE) and motor evoked potentials (MEPs) of the paretic middle deltoid (D), biceps brachii (BB), and abductor pollicis brevis muscles were assessed before rehabilitation (A-begin), immediately at its end (A-end), and 3 months later (A-3m). Changes in the FMUE scores and MEP variables were used for comparisons among groups.

Results

Both rehabilitation conditions resulted in a greater than 10% increase in the mean FMUE score. Group I showed a significant improvement in MEP variables (lower resting threshold, shorter central motor conduction time, and higher amplitude) in the three tested muscles. Group II showed a significant improvement in all the MEP variables of abductor pollicis brevis muscle and an increase in the MEP amplitude of only the BB muscle. Changes in the MEP threshold and amplitude of D and BB muscles were significantly higher in the patients in group I than those in group II.

Conclusion

Active bilateral upper limb swinging during treadmill training is more effective in improving paretic upper limb motor performance than training with supported upper limbs on treadmill handrails. Central neural plasticity may be underlying this recovery. Task-dependent neuronal coupling between lower and upper limb muscles during walking could be beneficial in stroke rehabilitation.

References

  1. Parker VM, Wade DT, Langton HR. Loss of arm function after stroke: measurement, frequency and recovery. Int Rehabil Med 1986; 8:69–73.

    Article  CAS  Google Scholar 

  2. Kluding P, Billinger SA. Exercise-induced changes of the upper extremity in chronic stroke survivors. Top Stroke Rehabil 2005; 12:58–68.

    Article  Google Scholar 

  3. Wolpaw JR, Carp JS. Plasticity from muscle to brain. Prog Neurobiol 2006; 78:233–263.

    Article  Google Scholar 

  4. Ploughman M, McCarthy J, Bosse M, Sullivan HJ, Corbett D. Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial. Arch Phys Med Rehabil 2008; 89:2041–2047.

    Article  Google Scholar 

  5. O’Malley MK, Ro T, Levin HS. Assessing and inducing neuroplasticity with transcranial magnetic stimulation and robotics for motor function. Arch Phys Med Rehabil 2006; 87:S59–S66.

    Article  Google Scholar 

  6. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther 1987; 7:206–207.

    Article  Google Scholar 

  7. Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001; 22:1527–1560.

    Article  CAS  Google Scholar 

  8. Lindquist ARR, Prado CL, Barros RML, Mattioli R, Lobo da Costa PH, Salvini TF. Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait. Phys Ther 2007;87:1144–1154.

    Article  Google Scholar 

  9. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002; 16:232–240.

    Article  Google Scholar 

  10. Chen R, Cros D, Curra A, Lazzaro VD, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008; 119:504–532.

    Article  Google Scholar 

  11. Dvorak J, Herdmann J, Vohnkas S. Motor evoked potentials by means of magnetic stimulation in disorders of the spine. Methods Clin Neurophysiol 1998; 3:45–64.

    Google Scholar 

  12. Baiter JE, Zehr EP. Neural coupling between the arms and legs during rhythmic locomotor-like cycling movement. J Neurophysiol 2007; 97:1809–1818.

    Article  Google Scholar 

  13. Juvin L, Simmers J, Morin D. Propriospinal circuitry underlying interlimb coordination in mammalian quadrupedal locomotion. J Neurosci 2005; 25:6025–6035.

    Article  CAS  Google Scholar 

  14. Dietz V, Fouad K, Bastiaanse CM. Neuronal coordination of arm and leg movements during human locomotion. Eur J Neurosci 2001; 14:1906–1914.

    Article  CAS  Google Scholar 

  15. Billinger SA, Cho J, Bouckhout V, Gobert DV. Total body reciprocal training improves hand function in chronic stroke survivors [abstract]. Stroke 2004; 35:287.

    Google Scholar 

  16. Asanuma H, Keller A. Neuronal mechanisms of motor learning in mammals. Neuroreport 1991; 2:217–224.

    Article  CAS  Google Scholar 

  17. Whitall J, Waller SM, Silver KH, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke 2000; 31:2390–2395.

    Article  CAS  Google Scholar 

  18. Shinohara M, Keenan KG, Enoka RM. Contralateral activity in a homologous hand muscle during voluntary contractions is greater in old adults. J Appl Physiol (1985) 2003; 94:966–974.

    Article  Google Scholar 

  19. Zijdewind I, Kernell D. Bilateral interactions during contractions of intrinsic hand muscles. J Neurophysiol 2001; 85:1907–1913.

    Article  CAS  Google Scholar 

  20. Pereira AC, Huddleston DE, Brickman AM, Sosunov AA, Hen R, McKhann GM, et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proc Natl Acad Sci USA 2007; 104:5638–5643.

    Article  CAS  Google Scholar 

  21. Ploughman M, Granter-Button S, Chernenko G, Tucker BA, Mearow KM, Corbett D. Endurance exercise regimens induce differential effects on brain-derived neurotrophic factor, synapsin-l and insulin-like growth factor I after focal ischemia. Neuroscience 2005; 136:991–1001.

    Article  CAS  Google Scholar 

  22. Miyai I, Tanabe HC, Sase I, Eda H, Oda I, Konishi I, et al. Cortical mapping of gait in humans: a near-infrared spectroscopic topography study. Neuroimage 2001; 14:1186–1192.

    Article  CAS  Google Scholar 

  23. Russo-Neustadt A, Beard RC, Cotman CW. Exercise, antidepressant medications, and enhanced brain derived neurotrophic factor expression. Neuropsychopharmacology 1999; 21:679–682.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, 21531, Alexandria, Egypt

    Enas M. Shahine MD & Tarek S. Shafshak

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  1. Enas M. Shahine MD
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  2. Tarek S. Shafshak
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Correspondence to Enas M. Shahine MD.

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Shahine, E.M., Shafshak, T.S. Central neuroplasticity and functional outcome of swinging upper limbs following repetitive locomotor training of lower limbs in stroke patients. Egypt Rheumatol Rehabil 41, 14–19 (2014). https://doi.org/10.4103/1110-161X.128130

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  • DOI: https://doi.org/10.4103/1110-161X.128130

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