Article

Recent research demonstrated that symmetry of corticomotor drive to
paretic and nonparetic plantarflexor muscles are related to the biomechanical
ankle moment strategy that individuals with chronic stroke used to achieve their
greatest walking speeds. Rehabilitation strategies that promote corticomotor
balance could potentially improve post-stroke walking mechanics and enhance
functional ambulation.
Objective: To 1) 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
2) determine if changes in corticomotor symmetry relate to changes in ankle
moment symmetry within the session. Design: A repeated measures cross-over study.
Methods: On separate days, twenty individuals with chronic stroke completed a
session of treadmill walking either with or without the use of FES to their ankle
dorsi- and plantarflexors muscles. We calculated plantarflexor corticomotor
symmetry using transcranial magnetic stimulation and plantarflexion ankle moment
symmetry during walking between the paretic and nonparetic limbs before and after
each session. We compared changes and tested relationships between corticomotor
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. Limitations: No stratification was made based on lesion size,
location, or clinical severity. Conclusions: For the first time, these findings
demonstrate the ability of a single session of gait training with FES to induce
positive corticomotor plasticity in individuals in the chronic stage of stroke
recovery and provide insight into the neurophysiologic mechanisms underlying
improvements in biomechanical walking function.

Langue : ANGLAIS