Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients

Abstract

Objective: To explore central neuroplasticity underlying lower limbs functional improvement following repetitive locomotor training by electromechanical gait trainer compared to treadmill with partial body weight support (PBWS) in chronic hemiparetic stroke. Design: Randomized, controlled study. Setting: Repetitive locomotor training. Participants: Fifty chronic hemiparetic stroke patients allocated into 2 groups. Interventions: Group 1 trained on electromechanical gait trainer of Hesse and group 2 trained on a treadmill with PBWS. Main Outcome Measures: Fugel-Meyer lower extremity motor performance test (FM) and motor evoked potential (MEP) of paretic rectus femoris (RF), tibialis anterior (TA) and gastrocnemius (GC) muscles were assessed at beginning, end of 8-week training, and 3 months. Results: Group 1 scored higher postrehabilitation FM. In group 1, MEP variables showed postrehabilitation improvement (lower resting threshold, shorter latency and higher amplitude). Group 2 showed improvement in MEP variables except for MEP latency of TA and GC. Higher percentage of group 1 patients had obtainable MEP at study end. Percent changes in FM score and MEP variables were higher in group 1. In group 1, percent change of FM correlated positively with percent change of MEP amplitude of TA and RF and negatively with percent change of MEP latency of GC. In group 2, percent change of FM score correlated positively with percent change of MEP amplitude of RF and GC. Conclusions: Electromechanical gait trainer is effective in promoting lower limb functional recovery in chronic hemiparetic stroke, and central neural plasticity is underlying this recovery. This can help to optimize the therapeutic approach in chronic stroke rehabilitation with less number and facilitated work of the therapist.