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Brain Sciences
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New Researches for Gait Rehabilitation after Stroke
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New Researches for Gait Rehabilitation after Stroke

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Behavioral Neuroscience".

Deadline for manuscript submissions: closed (25 February 2021) | Viewed by 10396

Special Issue Editor

Prof. Dr. Sangeetha Madhavan

E-Mail Website
Guest Editor
Department of Physical Therapy, University of Illinois Chicago, Chicago, IL 60612, USA
Interests: stroke; cortical priming; neuroplasticity; gait

Special Issue Information

Dear Colleagues,

Strokes have devastating consequences on functional ability. Deficits in walking after stroke affect activities of daily living and community ambulation, thereby reducing quality of life. Improvement in walking function is often cited as a primary goal of rehabilitation from stroke, and motor training is the most effective way to reduce impairment and regain function. However, current gait rehabilitation protocols have not demonstrated a return to walking level that enables full community participation. Hence, there is a critical need to maximize the benefits of current gait training protocols for stroke survivors. In this Special Issue of Brain Sciences, we focus on approaches that maximize the benefits of gait training for stroke through new approaches to walking training including the understanding of underlying neural and biomechanical mechanisms behind gait recovery, principles for gait retraining, approaches that can augment benefits of gait training such as cortical priming, dual task paradigms, and virtual reality, and assistive devices such as functional electrical stimulation and robotic devices. Our goal is to contribute towards the development of an implicit understanding of mechanisms that contribute to post-stroke walking recovery and discuss optimal evidence-based gait training strategies that can benefit stroke gait rehabilitation.

Prof. Dr. Sangeetha Madhavan
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gait
  • stroke
  • rehabilitation
  • brain

Published Papers (4 papers)

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Research

12 pages, 694 KiB  
Article
Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke
by Francesco Infarinato, Paola Romano, Michela Goffredo, Marco Ottaviani, Daniele Galafate, Annalisa Gison, Simone Petruccelli, Sanaz Pournajaf and Marco Franceschini
Brain Sci. 2021, 11(4), 448; https://doi.org/10.3390/brainsci11040448 - 01 Apr 2021
Cited by 11 | Viewed by 2564
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post [...] Read more.
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. Methods: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. Conclusions: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. Results: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects’ characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns. Full article
(This article belongs to the Special Issue New Researches for Gait Rehabilitation after Stroke)
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8 pages, 799 KiB  
Article
Is Lateropulsion Really Related with a Specific Lesion of the Brain?
by Kyoung Bo Lee, Sang Won Yoo, Eun Kyu Ji, Woo Seop Hwang, Yeun Jie Yoo, Mi-Jeong Yoon, Bo Young Hong and Seong Hoon Lim
Brain Sci. 2021, 11(3), 354; https://doi.org/10.3390/brainsci11030354 - 10 Mar 2021
Cited by 6 | Viewed by 2388
Abstract
Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present [...] Read more.
Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients. Full article
(This article belongs to the Special Issue New Researches for Gait Rehabilitation after Stroke)
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14 pages, 974 KiB  
Article
Characterization of Motor-Evoked Responses Obtained with Transcutaneous Electrical Spinal Stimulation from the Lower-Limb Muscles after Stroke
by Yaejin Moon, Taylor Zuleger, Martina Lamberti, Ashir Bansal, Chaithanya K. Mummidisetty, Kelly A. McKenzie, Lindsey Yingling, Sangeetha Madhavan, Elliot J. Roth, Richard L. Lieber and Arun Jayaraman
Brain Sci. 2021, 11(3), 289; https://doi.org/10.3390/brainsci11030289 - 26 Feb 2021
Cited by 6 | Viewed by 2496
Abstract
An increasing number of studies suggests that a novel neuromodulation technique targeting the spinal circuitry enhances gait rehabilitation, but research on its application to stroke survivors is limited. Therefore, we investigated the characteristics of spinal motor-evoked responses (sMERs) from lower-limb muscles obtained by [...] Read more.
An increasing number of studies suggests that a novel neuromodulation technique targeting the spinal circuitry enhances gait rehabilitation, but research on its application to stroke survivors is limited. Therefore, we investigated the characteristics of spinal motor-evoked responses (sMERs) from lower-limb muscles obtained by transcutaneous spinal cord stimulation (tSCS) after stroke compared to age-matched and younger controls without stroke. Thirty participants (ten stroke survivors, ten age-matched controls, and ten younger controls) completed the study. By using tSCS applied between the L1 and L2 vertebral levels, we compared sMER characteristics (resting motor threshold (RMT), slope of the recruitment curve, and latency) of the tibialis anterior (TA) and medial gastrocnemius (MG) muscles among groups. A single pulse of stimulation was delivered in 5 mA increments, increasing from 5 mA to 250 mA or until the subjects reached their maximum tolerance. The stroke group had an increased RMT (27–51%) compared to both age-matched (TA: p = 0.032; MG: p = 0.005) and younger controls (TA: p < 0.001; MG: p < 0.001). For the TA muscle, the paretic side demonstrated a 13% increased latency compared to the non-paretic side in the stroke group (p = 0.010). Age-matched controls also exhibited an increased RMT compared to younger controls (TA: p = 0.002; MG: p = 0.007), suggesting that altered sMER characteristics present in stroke survivors may result from both stroke and normal aging. This observation may provide implications for altered spinal motor output after stroke and demonstrates the feasibility of using sMER characteristics as an assessment after stroke. Full article
(This article belongs to the Special Issue New Researches for Gait Rehabilitation after Stroke)
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12 pages, 574 KiB  
Article
Feasibility and Safety of Transcranial Direct Current Stimulation in an Outpatient Rehabilitation Setting After Stroke
by Brice T. Cleland, Melissa Galick, Amy Huckstep, Laura Lenhart and Sangeetha Madhavan
Brain Sci. 2020, 10(10), 719; https://doi.org/10.3390/brainsci10100719 - 09 Oct 2020
Cited by 9 | Viewed by 2459
Abstract
Transcranial direct current stimulation (tDCS) has strong potential for outpatient clinical use, but feasibility and safety of tDCS has only been evaluated in laboratory and inpatient clinical settings. The objective of this study was to assess feasibility and safety of tDCS for stroke [...] Read more.
Transcranial direct current stimulation (tDCS) has strong potential for outpatient clinical use, but feasibility and safety of tDCS has only been evaluated in laboratory and inpatient clinical settings. The objective of this study was to assess feasibility and safety of tDCS for stroke in an outpatient clinical setting. Individuals with stroke in outpatient therapy received tDCS during physical therapy sessions. Feasibility was assessed with screening, enrollment, withdrawal, and adherence numbers, tDCS impressions, and perceived benefits and detriments of tDCS. Acute changes in fatigue and self-reported function and pre-post changes in fatigue were also assessed. Safety was assessed as adverse events and side effects. In total, 85 individuals were screened, and 10 were enrolled. Most exclusions were unrelated to clinical feasibility. In total, 3 participants withdrew, so 7 participants completed 2 sessions/week for 5–6 weeks with 100% adherence. In total, 71% reported positive impressions of tDCS. tDCS setup decreased to 5–7 min at end of study. There was one adverse event unrelated to tDCS. Mild to moderate side effects (tingling, itching, pinching, and fatigue) were experienced. In total, 86% of participants recounted benefits of tDCS. There were acute improvements in function and energy. Results support the feasibility and safety of tDCS in an outpatient clinical setting. Full article
(This article belongs to the Special Issue New Researches for Gait Rehabilitation after Stroke)
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