Sensory electrical stimulation improves foot placement during targeted stepping post-stroke

Abstract

Proper foot placement is vital for maintaining balance during walking, requiring the integration of multiple sensory signals with motor commands. Disruption of brain structures post-stroke likely alters the processing of sensory information by motor centers, interfering with precision control of foot placement and walking function for stroke survivors. In this study, we examined whether somatosensory stimulation, which improves functional movements of the paretic hand, could be used to improve foot placement of the paretic limb. Foot placement was evaluated before, during, and after application of somatosensory electrical stimulation to the paretic foot during a targeted stepping task. Starting from standing, twelve chronic stroke participants initiated movement with the non-paretic limb and stepped to one of five target locations projected onto the floor with distances normalized to the paretic stride length. Targeting error and lower extremity kinematics were used to assess changes in foot placement and limb control due to somatosensory stimulation. Significant reductions in placement error in the medial–lateral direction (p = 0.008) were observed during the stimulation and post-stimulation blocks. Seven participants, presenting with a hip circumduction walking pattern, had reductions (p = 0.008) in the magnitude and duration of hip abduction during swing with somatosensory stimulation. Reductions in circumduction correlated with both functional and clinical measures, with larger improvements observed in participants with greater impairment. The results of this study suggest that somatosensory stimulation of the paretic foot applied during movement can improve the precision control of foot placement.

Effects of Excitatory Transcranial Magnetic Stimulation of the Anterior Intraparietal Area in Chronic Stroke Patients

“…Several studies have pointed the relevance of the sensory function motor performance after stroke [33][34][35][36]. A rehabilitation that aims to improve sensory functions tends to produce better results [34][35] since sensory integration is the base of the elaboration and structure of movement [33]. In this study, the excitatory stimulation of the anterior intraparietal area increased the sensory function score of the three participants, reaching the subsection maximum score for patients 1 and 2.…”

“…We found an increase in motor function, sensory function, and pain level scores for the affected lower and upper extremities of chronic stroke patients, suggesting that rTMS of the spared anterior intraparietal area may yield wide-ranging benefits. Several studies have pointed the relevance of the sensory function motor performance after stroke [33][34][35][36]. A rehabilitation that aims to improve sensory functions tends to produce better results [34][35] since sensory integration is the base of the elaboration and structure of movement [33].…”

Effects of Excitatory Repetitive Transcranial Magnetic Stimulation of the P3 Point in Chronic Stroke Patients – Case Reports

“…Several studies have pointed the relevance of the sensory function motor performance after stroke [44][45][46][47]. A rehabilitation that aims to improve sensory functions tends to produce better results [45][46] since sensory integration is the base of the elaboration and structure of movement [44]. In this study, the excitatory stimulation of the P3 point increased the sensory function score of the three tread participants, reaching the subsection maximum score for patients 1 and 2.…”

“…Although the patient reported some difficulty in performing activities of daily living (ADLs) with the right hand, FMA was unable to find any impairment in motor function subsection, since she reached the highest score Score variations by subsection for lower limb and upper limb can be found in Figure 3 and Figure 4, respectively. Several studies have pointed the relevance of the sensory function motor performance after stroke [44][45][46][47]. A rehabilitation that aims to improve sensory functions tends to produce better results [45][46] since sensory integration is the base of the elaboration and structure of movement [44].…”

Effects of hip abduction and adduction accuracy on post-stroke gait

“…In addition, interventions designed to enhance available sensory feedback could contribute to improvements in movement accuracy. Specific to hip abduction, vibratory stimuli may hold promise for modulating the sensory feedback used to control foot placement location [Walker et al 2014; Roden-Reynolds et al 2015]. An appropriate combination of behavioral training and enhanced sensation may allow improvement of post-stroke hip abduction accuracy and gait function.…”