Abstract
BackgroundThe ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject’s brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated.MethodsA control subject and a post-stroke patient with chronic hemiparesis were studied. Functional magnetic resonance images were acquired during a block-design protocol on both subjects while performing passive and active ankle dorsal/plantarflexion. fMRI and gait analysis were assessed on the patient before and after electromyographic biofeedback rehabilitation treatment during gait activities. Lower limb three-dimensional kinematics, kinetics and surface electromyography were evaluated. Correlation between fMRI and gait analysis categorical variables was assessed: agreement/disagreement was assigned to each variable if the value was in/outside the normative range (gait analysis), or for presence of normal/diffuse/no activation of motor area (fMRI).ResultsAltered fMRI activity was found on the post-stroke patient before biofeedback rehabilitation with respect to the control one. Meanwhile the patient showed a diffuse, but more limited brain activation after treatment (less voxels). The post-stroke gait data showed a trend towards the normal range: speed, stride length, ankle power, and ankle positive work increased. Preliminary correlation analysis revealed that consistent changes were observed both for the fMRI data, and the gait analysis data after treatment (R > 0.89): this could be related to the possible effects BFB might have on the central as well as on the peripheral nervous system.ConclusionsOur findings showed that this methodology allows evaluation of the relationship between alterations in gait and brain activation of a post-stroke patient. Such methodology, if applied on a larger sample subjects, could provide information about the specific motor area involved in a rehabilitation treatment.
Highlights
The ability to walk independently is a primary goal for rehabilitation after stroke
To evaluate potential relationships between activations in patients and their ability to walk, we used functional magnetic resonance imaging (fMRI) data to evaluate the cerebral activity during active and passive ankle dorsalplantarflexion (ADPF); afterward we investigated the correlations between the fMRI results and gait analysis data before and after 5 weeks of electromyographic biofeedback during gait rehabilitation
FMRI results At time T1, concerning the active task A, individual brain activation maps revealed activation of the right primary motor area (MI) both for the control subject and for the patient when the left ankle was activated, in addition the premotor cortex was shown to be active for the patient (Figures 2 and 3); while considering the right paretic side of the patient a diffuse activation of the right pre-motor cortex and of the visual area was observed (Figure 3)
Summary
The ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject’s brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated. Patients with persistent hemiparesis walk approximately one third as fast and only 40% the distance of age-matched healthy persons [1]. In this context additional gait training and rehabilitation treatments can improve walking speed and endurance [1]. Patients with hemiparesis tend to have a severe reduction of ankle power in the push-off phase of gait as well as a much reduced velocity in gait
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