Abstract
Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours. However, long-term locomotor training-related neuroplasticity remains unexplored. We compared the effects of end-effector robot-assisted gait training (E-RAGT) and bodyweight-supported treadmill training (BWST) on cortical activation in individuals with hemiparetic stroke. Twenty-three men and five women aged 53.2 ± 11.2 years were recruited and randomly assigned to participate in E-RAGT (n = 14) or BWST (n = 14) for 30 min/day, 5 days/week, for 4 weeks. Cortical activity, lower limb motor function, and gait speed were evaluated before and after training. Activation of the primary sensorimotor cortex, supplementary motor area, and premotor cortex in the affected hemisphere significantly increased only in the E-RAGT group, although there were no significant between-group differences. Clinical outcomes, including the Fugl-Meyer assessment (FMA), timed up and go test, and 10-m walk test scores, improved after training in both groups, with significantly better FMA scores in the E-RAGT group than in the BWST group. These findings suggest that E-RAGT effectively improves neuroplastic outcomes in hemiparetic stroke, although its superiority over conventional training remains unclear. This may have clinical implications and provides insight for clinicians interested in locomotor neurorehabilitation after hemiparetic stroke.Trial Registration: ClinicalTrials.gov Identifier NCT04054739 (12/08/2019).
Highlights
Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours
Clinical robot-assisted gait training (RAGT) studies have shown improvements in independent gait scale, lower limb motor function, and walking s peed[11,12]. Such functional locomotor recovery has been associated with neuroplastic improvement in hemiplegic stroke, including increased motor-evoked potential amplitude in repetitive transcranial magnetic stimulation studies[13,14,15]; restoration of the corticospinal tract in diffusion tensor tractography s tudies[16,17]; bihemispheric reorganisation evolved from contralesional primary sensorimotor cortex (SMC) to ipsilesional SMC in functional magnetic resonance imaging studies[18,19,20]; and dissolution of abnormal activations and increased activation of the ipsilesional SMC in an fMRI study[21]
In the effector robot-assisted gait training (E-RAGT) group, significant within-group differences between pre-test and post-test were noted for the activity of the SMC (p = 0.016), supplementary motor area (SMA) (p = 0.022), and premotor cortex (PMC) (p = 0.009) over the affected hemisphere
Summary
Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours. Clinical RAGT studies have shown improvements in independent gait scale, lower limb motor function, and walking s peed[11,12] Such functional locomotor recovery has been associated with neuroplastic improvement in hemiplegic stroke, including increased motor-evoked potential amplitude in repetitive transcranial magnetic stimulation studies[13,14,15]; restoration of the corticospinal tract in diffusion tensor tractography s tudies[16,17]; bihemispheric reorganisation evolved from contralesional primary sensorimotor cortex (SMC) to ipsilesional SMC in functional magnetic resonance imaging (fMRI) studies[18,19,20]; and dissolution of abnormal activations and increased activation of the ipsilesional SMC in an fMRI study[21]. This hypothesis has not been tested with E-RAGT to date
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