Single Session of Functional Electrical Stimulation-Assisted Walking Produces Corticomotor Symmetry Changes Related to Changes in Poststroke Walking Mechanics.
BACKGROUND
Recent research demonstrated that the symmetry of corticomotor drive with the paretic and nonparetic plantarflexor muscles was related to the biomechanical ankle moment strategy that people with chronic stroke used to achieve their greatest walking speeds. Rehabilitation strategies that promote corticomotor balance might improve poststroke walking mechanics and enhance functional ambulation.


OBJECTIVE
The study objectives were to test the effectiveness of a single session of gait training using functional electrical stimulation (FES) to improve plantarflexor corticomotor symmetry and plantarflexion ankle moment symmetry and to determine whether changes in corticomotor symmetry were related to changes in ankle moment symmetry within the session.


METHODS
This was a repeated-measures crossover study.


METHODS
On separate days, 20 people with chronic stroke completed a session of treadmill walking either with or without the use of FES of their ankle dorsi- and plantarflexor muscles. We calculated plantarflexor corticomotor symmetry using transcranial magnetic stimulation and plantarflexion ankle moment symmetry during walking between the paretic and the nonparetic limbs before and after each session. We compared changes and tested relationships between corticomotor symmetry and ankle moment symmetry following each session.


RESULTS
Following the session with FES, there was an increase in plantarflexor corticomotor symmetry that was related to the observed increase in ankle moment symmetry. In contrast, following the session without FES, there were no changes in corticomotor symmetry or ankle moment symmetry.


CONCLUSIONS
No stratification was made on the basis of lesion size, location, or clinical severity.


CONCLUSIONS
These findings demonstrate, for the first time (to our knowledge), the ability of a single session of gait training with FES to induce positive corticomotor plasticity in people in the chronic stage of stroke recovery. They also provide insight into the neurophysiologic mechanisms underlying improvements in biomechanical walking function.
Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, RG36A, Atlanta, GA 30322 (USA).
Jacqueline A
JA
Palmer
Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland.
HaoYuan
H
Hsiao
Department of Physical Therapy, University of Delaware, Delaware.
Tamara
T
Wright
Department of Physical Therapy, University of Delaware, and Graduate Program in Biomechanics and Movement Science, University of Delaware, Delaware.
Stuart A
SA
Binder-Macleod
D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome