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Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients

Abstract

Objective

To evaluate the efficacy of electromechanical gait training (EGT) versus treadmill training with partial body weight support (TTPBWS) on lower limb motor performance (MP) and on motor evoked potential (MEP) in patients with chronic stroke.

Patients and Methods

Fifty patients (age 43–75 years) with hemiparetic stroke (7–72 months’ duration) were allocated randomly to two groups. Patients of group I (n = 25) received EGT and those of group II (n = 25) received TTPBWS (20 min/day, 6 days/week for 8 weeks). Main outcome measurements: Fugel-Meyer lower extremity (FMLE) MP test and MEP were assessed in all patients before rehabilitation (A-begin), at the end of rehabilitation (A-end), and 3 months later (A-3m). By transcranial magnetic stimulation, MEP threshold, MEP amplitude (MEPamp), and cortical latencies to the rectus femoris, tibialis anterior, and gastrocnemius (GC) muscles were assessed.

Results

Better improvement in FMLE was observed in group I compared with group II. In group I, FMLE scores improved significantly at A-3m compared with A-end. A significant reduction in GC cortical latencies and increase in GC MEPamp on the second and third follow-up were observed in group I compared with group II. Although all MEP parameters of the three lower limb muscles tested improved throughout the follow-up periods on intragroup compression, they did not reach statistically significant levels. More patients in group I (unlike group II) with unobtainable MEP at A-begin had obtainable MEP at A-end and A-3m from rectus femoris and GC muscles. The change in MEPamp was the most frequent MEP variable that correlated with the change in FMLE scores (in either group).

Conclusion

Better improvement in MP was observed following EGT at A-3m. Therefore, one EGT rather than TTPBWS may be recommended to improve lower extremity MP in chronic ambulatory stroke patients.

References

  1. Patel AT, Duncan PW, Lai SM, Studenski S. The relation between impairments and functional outcome post stroke. Arch Phys Med Rehabil 2000; 81:1357–1363.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  3. Hesse S, Werner C, von Frankenberg S, Bardeleben A. Treadmill training with partial body weight support after stroke. Phys Med Rehabil Clin N Am 2003; 14:S111–S123.

    Article  Google Scholar 

  4. Hesse S, Werner C, Uhlenbrock D, Von Frankenberg S, Bardeleben A, Brandl-Hesse B. An electromechanical gait trainer for restoration of gait in hemiparetic stroke patients: preliminary results. Neurorehabil Neural Repair 2001; 15:39–50.

    Article  CAS  Google Scholar 

  5. Werner C, von Frankenberg S, Treig T, Bardeleben A, Hesse S. Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomised cross-over study. Stroke 2002; 33:111–118.

    Article  Google Scholar 

  6. Luft AR, Macko RF, Forrester LW , et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke 2008; 39:3341–3350.

    Article  Google Scholar 

  7. Hallett M. Transcranial magnetic stimulation and human brain. Nature 2000; 406:145–150.

    Article  Google Scholar 

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

    Article  Google Scholar 

  9. Hesse S, Schmidt H, Werner C. Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin. J Rehabil Res Dev 2006; 43:671–678.

    Article  Google Scholar 

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

    Article  Google Scholar 

  11. Chen R, Cros D, Curra A, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008; 119:504–532.

    Article  Google Scholar 

  12. Kosak MC, Reding MJ. Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. Neurorehabil Neural Repair 2000; 14:13–19.

    Article  CAS  Google Scholar 

  13. Dietz V. Spinal cord pattern generators for locomotion. Clin Neurophysiol 2003; 114:1379–1389.

    Article  CAS  Google Scholar 

  14. Hesse S, Uhlenbrock D, Sarkodie-Gyan T. Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clin Rehabil 1999; 13:401–410.

    Article  CAS  Google Scholar 

  15. Forrester LW, Hanley DF, Macko RF. Effects of treadmill exercise on transcranial magnetic stimulation-induced excitability to quadriceps after stroke. Arch Phys Med Rehabil 2006; 87:229–234.

    Article  Google Scholar 

  16. Pendlebury ST, Blamire AM, Lee MA, Styles P, Matthews PM. Axonal injury in the internal capsule correlates with motor impairment after stroke. Stroke 1999; 30:956–962.

    Article  CAS  Google Scholar 

  17. Thickbroom GW, Bymes ML, Archer SA, Mastaglia FL. Motor outcome after subcortical stroke correlates with the degree of cortical reorganization. Clin Neurophysiol 2004; 115:2144–2150.

    Article  Google Scholar 

  18. Larry WF, Lewis AW, Andreas RL. Exercise mediated locomotor recovery and lower limb neuroplasticity after stroke. J Rehabil Res Dev 2008; 45:205–220.

    Article  Google Scholar 

  19. Macko RF, Smith GV, Dobrovolny CL, Sorkin JD, Goldberg AP, Silver KH. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil 2001; 82:879–884.

    Article  CAS  Google Scholar 

  20. Edgerton VR, Tillakaratne NJK, Bigbee AJ, de Leon RD, Roy RR. Plasticity of the spinal neural circuitry after injury. Annu Rev Neurosci 2004; 27: 145–167.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

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Correspondence to Enas M. Shahine MD.

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Shahine, E.M., Shafshak, T.S. Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients. Egypt Rheumatol Rehabil 41, 85–91 (2014). https://doi.org/10.4103/1110-161X.140520

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Keywords

  • locomotor training
  • motor evoked potential
  • neuroplasticity
  • treadmill with partial body weight support