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This version was published on February 1, 2008
Neurorehabilitation and Neural Repair, Vol. 22, No. 1, 22-30 (2008)
DOI: 10.1177/1545968307301875

Gait Training—Induced Change in Corticomotor Excitability in Patients With Chronic Stroke

Chu-Ling Yen, MS, PT

Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan

Ray-Yau Wang, PhD, PT

Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Department of Education and Research, Taipei City Hospital, Taipie, Taiwan

Kwong-Kum Liao, MD

Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

Chia-Chi Huang, MS, PT

Physical Therapy, Department of Physical Medicine and Rehabilitation Taipei Veterans General Hospital, Taipei, Taiwan

Yea-Ru Yang, PhD, PT

Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, yryang{at}ym.edu.tw, Section of Physical Therapy Taipei City Hospital, Taipei, Taiwan

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. Objectives. 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.

Key Words: Body weight • supported treadmill training • Balance and gait • Transcranial magnetic stimulation • Corticomotor excitability • Stroke

References

  • Chen G., Patten C., Kothari DH, et al. Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait Posture. 2005;22:51-56.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Goldie PA, Matyas TA, Evans OM Gait after stroke: initial deficit and changes in temporal patterns for each gait phase. Arch Phys Med Rehabil. 2001;82:1057-1065.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Smith GV, Silver KH, Goldberg AP, et al. "Task-oriented" exercise improves hamstring strength and spastic reflexes in chronic stroke patients. Stroke. 1999;30:2112-2118.[Abstract/Free Full Text]
  • Laufer Y., Dickstein R., Chefez Y., et al. The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. J Rehabil Res Dev. 2001;38:69-78.[ISI][Medline] [Order article via Infotrieve]
  • Richards CL, Malouin F., Wood-Dauphinee S., et al. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Arch Phys Med Rehabil. 1993;74:612-620.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Malouin F., Potvin M., Prevost J., et al. Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents. Phys Ther. 1992;72:781-793.[Abstract/Free Full Text]
  • Macko RF, Ivey FM, Forrester LW, et al. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke. 2005;36:2206-2211.[Abstract/Free Full Text]
  • Silver KH, Macko RF, Forrester LW, et al. Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke: a preliminary report. Neurorehabil Neural Repair. 2000;14:65-71.[Abstract/Free Full Text]
  • Waagfjord J., Levangie PK, Certo CM Effects of treadmill training on gait in a hemiparetic patient. Phys Ther. 1990;70:549-560.[Abstract]
  • Barbeau H., Visintin M. Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil. 2003;84:1458-1465.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Hesse S., Bertelt C., Schaffrin A., et al. Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. Arch Phys Med Rehabil. 1994;75:1087-1093.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Hesse S., Bertelt C., Jahnke MT, et al. Treadmill training with partial body weight support compared with physiotherapy in non-ambulatory hemiparetic patients. Stroke. 1995;26:976-981.[Abstract/Free Full Text]
  • Nilsson L., Carlsson J., Danielsson A., et al. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil. 2001;15:515-527.[Abstract/Free Full Text]
  • Visintin M., Barbeau H., Korner-Bitensky N., et al. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke. 1998;29:1122-1128.[Abstract/Free Full Text]
  • da Cunha IT, Lim PA, Qureshy H., et al. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Arch Phys Med Rehabil. 2002;83:1258-1265.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Mudge S., Rochester L., Recordon A. The effect of treadmill training on gait, balance and trunk control in a hemiplegic subject: a single system design. Disabil Rehabil. 2003;25:1000-1007.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Werner C., Bardeleben A., Mauritz KH, et al. Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Eur J Neurol. 2002;9:639-644.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Dobkin BH, Firestine A., West M., et al. Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation. Neuroimage. 2004;23:370-381.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Jang SH, Kim YH, Cho SH, et al. Cortical reorganization induced by task-oriented training in chronic hemiplegic stroke patients. Neuroreport. 2003;14:137-141.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Johansen-Berg H., Dawes H., Guy C., et al. Correlation between motor improvements and altered fMRI activity after rehabilitative therapy. Brain. 2002;125:2731-2742.[Abstract/Free Full Text]
  • Traversa R., Cicinelli P., Pasqualetti P., et al. Follow-up of inter-hemispheric differences of motor evoked potentials from the `affected' and `unaffected' hemispheres in human stroke. Brain Res. 1998;803:1-8.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Koski L., Mernar TJ, Dobkin BH Immediate and long-term changes in corticomotor output in response to rehabilitation: correlation with functional improvements in chronic stroke. Neurorehabil Neural Repair. 2004;18:230-249.[Abstract]
  • Liepert J., Graef S., Uhde I., et al. Training-induced changes of motor cortex representations in stroke patients. Acta Neurol Scand. 2000;101:321-326.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Luft AR, McCombe-Waller S., Whitall J., et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. JAMA. 2004;292:1853-1861.[Abstract/Free Full Text]
  • Carey JR, Kimberley TJ, Lewis SM, et al. Analysis of fMRI and finger tracking training in subjects with chronic stroke. Brain. 2002;125:773-788.[Abstract/Free Full Text]
  • Perez MA, Lungholt BK, Nyborg K., et al. Motor skill training induces changes in the excitability of the leg cortical area in healthy humans. Exp Brain Res. 2004;159:197-205.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Miyai I., Yagura H., Oda I., et al. Premotor cortex is involved in restoration of gait in stroke. Ann Neurol. 2002;52:188-194.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • 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.[CrossRef][Medline] [Order article via Infotrieve]
  • Lin PY, Yang YR, Cheng SJ, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87:562-568.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Brouwer B., Ashby P. Corticospinal projections to upper and lower limb spinal motoneurons in man. Electroencephalogr Clin Neurophysiol. 1990;76:509-519.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Jankowska E., Padel Y., Tanaka R. Projections of pyramidal tract cells to a-motoneurones innervating hind-limb muscles in the monkey. J Physiol. 1975;249:637-667.[Abstract/Free Full Text]
  • Calancie B., Alexeeva N., Broton JG, et al. Distribution and latency of muscle responses to transcranial magnetic stimulation of motor cortex after spinal cord injury in humans. J Neurotrauma. 1999;16:49-67.[ISI][Medline] [Order article via Infotrieve]
  • Terao Y., Ugawa Y., Hanajima R., et al. A single motor unit recording technique for studying the differential activation of corticospinal volleys by transcranial magnetic stimulation. Brain Res Protoc. 2001;7:61-67.[CrossRef][Medline] [Order article via Infotrieve]
  • Pascual-Leone A., Nguyet D., Cohen LG, et al. Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. J Neurophysiol. 1995;74:1037-1045.[Abstract/Free Full Text]
  • Liepert J., Terborg C., Weiller C. Motor plasticity induced by synchronized thumb and foot movements. Exp Brain Res. 1999;125:435-439.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Liepert J., Bauder H., Wolfgang HR, et al. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31:1210-1216.[Abstract/Free Full Text]
  • Wolf SL, Butler AJ, Campana GI, et al. Intra-subject reliability of parameters contributing to maps generated by transcranial magnetic stimulation in able-bodied adults. Clin Neurophysiol. 2004;115:1740-1747.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Calancie B., Molano MR, Broton JG Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man. Spinal Cord. 2004;42:573-580.[CrossRef][Medline] [Order article via Infotrieve]
  • Liepert J., Uhde I., Graf S., et al. Motor cortex plasticity during forced-use therapy in stroke patients: a preliminary study. J Neurol. 2001;248:315-321.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Liepert J., Miltner WHR, Bauder H., et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett. 1998;250:5-8.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Wittenberg GF, Chen R., Ishii K., et al. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Repair. 2003;17:48-57.[Abstract]
  • Byrnes ML, Thickbroom GW, Phillips BA, et al. Long-term changes in motor cortical organisation after recovery from sub-cortical stroke. Brain Res. 2001;889:278-287.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Mazzocchio R., Kitago T., Liuzzi G., et al. Plastic changes in the human H-reflex pathway at rest following skillful cycling training. Clin Neurophysiol. 2006;117:1682-1691.[CrossRef][Medline] [Order article via Infotrieve]

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