Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial

Abstract

Background A recent study has demonstrated that a turning-based treadmill program yields greater improvements in gait speed and temporal symmetry than regular treadmill training in chronic stroke patients. However, it remains unknown how this novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in chronic stroke patients. The purpose of this study was to examine how a novel type of gait training, which is an unfamiliar but effective task for people with chronic stroke, enhances brain reorganization. Methods Subjects in the experimental and control groups received 30 min of turning-based treadmill training and regular treadmill training, respectively. Cortico-cortical connectivity and cortico-muscular connectivity during walking and gait performance were assessed before and after completing the 12-session training. Results Eighteen subjects ( n = 9 per group) with a mean age of 52.5 ± 9.7 years and an overground walking speed of 0.61 ± 0.26 m/s consented and participated in this study. There were significant group by time interactions for gait speed, temporal gait symmetry, and cortico-cortical connectivity as well as cortico-muscular connectivity in walk-related frequency (24–40 Hz) over the frontal-central-parietal areas. Compared with the regular treadmill training, the turning-based treadmill training resulted in greater improvements in these measures. Moreover, the increases in cortico-cortical connectivity and cortico-muscular connectivity while walking were associated with improvements in temporal gait symmetry. Conclusions Our findings suggest this novel turning-based treadmill training is effective for enhancing brain functional reorganization underlying cortico-cortical and corticomuscular mechanisms and thus may result in gait improvement in people with chronic stroke. Trial registration ACTRN12617000190303 . Registered 3 February 2017, retrospectively registered.

Gait‐phase‐dependent and gait‐phase‐independent cortical activity across multiple regions involved in voluntary gait modifications in humans

“…sensorimotor cortex in the alpha and beta bands has been previously reported to be involved in muscle activation during steady-state walking at the swing phase with EEG-electromyogram (EMG) coherence analysis (Petersen et al, 2012;Chen et al, 2019). Considering these previous studies, the power decrease in the alpha and beta band in the central sensorimotor cortex during precision stepping might be related to sensorimotor information processing of the lower limbs for precise limb control at the swing phase.…”

Increased gait variability during robot-assisted walking is accompanied by increased sensorimotor brain activity in healthy people

“…In addition to biomechanical gait changes, insights into brain activity and intervention-related changes in brain activity that relate to gait responses, will contribute to the optimization of therapy interventions [41, 51]. Whereas the application of functional magnetic resonance imaging (fMRI), considered as gold standard for the assessment of activity in cortical and subcortical structures, is restricted due to the vulnerability for movement artifacts and the range of motion in the scanner [52], functional near infrared spectroscopy (fNIRS) is affordable and easily implementable in a portable system, less susceptible to motion artifacts, thus facilitation a wider range of application with special cohorts (e.g., children, patients) and in everyday environments (e.g., during a therapeutic session of RAW or UAW) [53, 54].…”

Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review

“…Test new rehabilitation paradigm [34,[58][59][60][61][62] Investigation of the efficacy of BMI [63] and EEG feedback [64] Study of movement classification combining EEG and EMG [65] Investigation of movement intention [66,67] and motor imagery detection [68] Study of the cortico-muscular coupling [69][70][71] Study of the neuroplasticity with electrical stimulation [72] Investigation of engagement in game rehabilitation [73] Study of the effects of the use of VR in facial rehabilitation [74] Randomized controlled trial Study the effects of transcranial [75,76] and peripheral electrical stimulation [77][78][79] Investigation of the efficacy of lower limb exoskeleton rehabilitation [80] Assessment of a novel gait training paradigm [81] Investigation of the efficacy of neurologic therapy based on music [82] Investigation of the effects of biofeedback [83] Methodological study Presentation of a multivariate approach for motor assessment [32,33] Presentation of a method for compressing EEG-EMG signal [84] Presentation of algorithms for motion detection [85,86] and motion classification [87,88] A total of 21 papers out of 55 (37%) presented observational studies in which functional parameters or effects of treatments were investigated on healthy subjects and patients. An aim commonly found in these works was the assessment of the cortico-muscular coupling during movements [37][38][39]…”

“…Bao et al [75] and Benninger et al [76] studied the efficacy of employing transcranial stimulation on stroke and parkinsonian patients, respectively, while three studies applied peripheral electrical stimulation on stroke patients [77][78][79]. Rehabilitation for stroke patients was investigated by Calabrò et al [80] using an exoskeleton and by Chen et al [81] with a novel treadmill. Furthermore, the efficacy of sensorial feedback based on music [82] or EEG/EMG biofeedback [83] in stroke patients was assessed during rehabilitation to improve motor recovery.…”