Brain Activity Changes Associated With Treadmill Training After Stroke

Abstract

Background and Purpose-The mechanisms underlying motor recovery after stroke are not fully understood. Several studies used functional MRI longitudinally to relate brain activity changes with performance gains of the upper limb after therapy, but research into training-induced recovery of lower limb function has been relatively neglected thus far. Methods-We investigated functional reorganization after 4 weeks of treadmill training with partial body weight support in 18 chronic patients (mean age, 59.9Ϯ13.5 years) with mild to moderate paresis (Motricity Index affected leg: 77.7Ϯ10.5; range, 9 to 99) and gait impairment (Functional Ambulation Category: 4.4Ϯ0.6; range, 3 to 5) due to a single subcortical ischemic stroke using repeated 3.0-T functional MRI and an ankle-dorsiflexion paradigm. Results-Walking endurance improved after training (2-minute timed walking distance: 121.5Ϯ39.0 versus pre:105.1Ϯ38.1 m; Pϭ0.0001). For active movement of the paretic foot versus rest, greater walking endurance correlated with increased brain activity in the bilateral primary sensorimotor cortices, the cingulate motor areas, and the caudate nuclei bilaterally and in the thalamus of the affected hemisphere. Conclusions-Despite the strong subcortical contributions to gait control, rehabilitation-associated walking improvements are associated with cortical activation changes. This is similar to findings in upper limb rehabilitation with some differences in the involved cortical areas. We observed bihemispheric activation increases with greater recovery both in cortical and subcortical regions with movement of the paretic foot. However, although the dorsal premotor cortex appears to play an important role in recovery of hand movements, evidence for the involvement of this region in lower extremity recovery was not found.

The effect of physical training on glutamate transporter expression in an experimental ischemic stroke rat model

“…A number of previous studies have investigated the role of exercise in promoting enhanced cell survival against brain ischemia and improved functional recovery [30,31]. Our result show that physical training significantly promoted the functional outcomes on day 14 after MCAO.…”

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient

“…Additionally, 1 RCT demonstrated that progressive treadmill walking improves cardiovascular fitness, economy of gait, and endurance (ie, 6-minute walk test) compared with stretching and low-intensity walking. 32 Recently, brain activity changes were observed with functional magnetic resonance imaging after treadmill training, 223,224 which suggests that cortical reorganization is possible during task-specific LE activity.…”

Infarct hemisphere and noninfarcted brain volumes affect locomotor performance following stroke

“…32,33 Increased brain activity within this region during active ankle movements has been linked to better walking performance in stroke subjects. 34 The cerebellum is critical for intralimb and interlimb coordination of cyclic movements, along with the dynamic regulation of balance. 35,36 Atrophy of this region has been linked to poor walking outcomes in community-dwelling older adults.…”