Gait training induced change in corticomotor excitability in patients with chronic stroke.
BACKGROUND
Numerous studies have reported the effects of gait training on motor performance after stroke. However, there is limited information on treatment-induced changes in corticomotor excitability.


OBJECTIVE
The purpose of the study was to investigate the effects of additional gait training on motor performance and corticomotor excitability and to demonstrate the relationship between motor improvement and corticomotor excitability change in patients with chronic stroke.


METHODS
Fourteen patients were randomly assigned to the experimental or control group. Participants in both groups participated in general physical therapy. Those in the experimental group received additional body weight- supported treadmill training for 4 weeks. All participants received baseline and posttreatment assessments. The outcome measures included assessment of the Berg Balance Scale (BBS) and gait parameters. Focal transcranial magnetic stimulation was used to measure the motor threshold, map size, and location of the amplitude-weighted center of gravity of the motor map for the tibialis anterior (TA) and abductor hallucis (AH) muscles.


RESULTS
After general physical therapy, we noted that the patients showed an improvement only in walking speed and cadence, and there were no significant changes in corticomotor excitability. After additional gait training, participants improved significantly on BBS score, walking speed, and step length. Moreover, the motor threshold for TA decreased significantly in the unaffected hemisphere. The map size for TA was increased in both hemispheres, whereas that for AH was increased only in the affected hemisphere. There were significant differences between the change scores of the groups in terms of walking speed, step length, and motor threshold for TA in the unaffected hemisphere and map size for AH in the affected hemisphere. Additionally, the changes in corticomotor excitability correlated with functional improvement.


CONCLUSIONS
Additional gait training may improve balance and gait performance and may induce changes in corticomotor excitability.
Yen
Chu-Ling
CL
Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan.
Wang
Ray-Yau
RY
Liao
Kwong-Kum
KK
Huang
Chia-Chi
CC
Yang
Yea-Ru
YR
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011712:Pyramidal Tracts / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome