Gait Recovery Research Articles

Abstract 152: Relationship Between Gait Function And Damage To Descending Motor Pathways After Stroke

Introduction: Descending motor pathways, namely the corticospinal (CST) and corticoreticular tracts (CRT), are important for normal gait function and have been implicated in gait recovery after stroke. However, the relationship of structural injury to these tracts and gait function in the acute and chronic stage post-stroke remains unclear. Methods: Gait velocity was recorded the first week (acute) after stroke (n=127) and one year later (n= 50). CST and CRT injury were measured using weighted lesion load (wLL). The impact of CST and CRT injury on ambulation status (non-ambulatory vs. ambulatory) and gait velocity was assessed with multivariate logistic and linear regression models, respectively, acutely and chronically, controlling for wLL and lesion size. Results: Greater CRT injury resulted in a higher odds of ambulation loss acutely post-stroke (odds ratio [95% CI, p value]: CRT wLL, 1.06 [1.02-1.12, 0.007]; CST wLL 0.97 [0.95-0.99, 0.04]; lesion volume 1.00 [0.99-1.00, 0.96]). Conversely, greater CST injury had higher odds of ambulation loss at one-year (CST wLL, 1.09 [1.01-1.21, 0.04]; CRT wLL, 0.98 [0.84-1.13, 0.75]; lesion volume, 1.00 [0.99-1.00, 0.81]). For walkers (N=51 [acute] and 46 [chronic]), gait velocity was not significantly associated with CRT nor CST wLL at either time. Multicollinearity results denoted lesion measures provided independent information (maximum variance inflation factors 3.4 (acute), 4.2 (one-year)). Conclusion: Results suggest CRT injury is the dominant correlate of ambulation loss acutely, with CST the dominant correlate of persistent loss after one-year. Gait velocity is not well explained by damage to either tract. The results imply that the CRT may be the primary cortical projection for normal (pre-stroke) gait. Yet, the nervous system has sufficient redundancy to compensate for unilateral CRT injury, while CST injury may have a more enduring negative impact on gait function.

Abstract WP58: Corticomotor Input Integrity To The Dorsi-plantarflexors And Motor Control In Chronic Stroke

Objective: To improve recovery of gait after stroke, we need to attain better understanding of lower extremity motor control. Transcranial magnetic stimulation (TMS) allows for evaluation of corticomotor input (CMI) integrity. Our objective was to explore the relationship between CMI to the dorsi-/plantarflexors and measures of motor impairment and gait speed. Methods: Fugl-Meyer for Lower Extremity (FM), gait speed and TMS Motor Evoked Potentials (MEP) were collected for 27 ambulatory chronic stroke survivors. Maximum MEPs (MEP max ) were collected for paretic and non-paretic tibialis anterior (TA) and lateral gastrocnemius muscles (Gastroc) using a cone-shaped TMS coil targeting primary motor cortices. We collected MEPs while seated participants activated their tested muscles to 20% of maximum effort. MEPs were normalized by the maximum compound muscle action potentials obtained by stimulation of the peripheral motor nerves. Symmetry of the corticospinal motor output was calculated as ratio of the normalized paretic and non-paretic MEP max . Analysis included descriptive statistics, paired t-test and Pearson correlation. Non-normally distributed data was log-transformed. Results: Study participants were 65.7±7.5 years old, 5.3±4.4 years after stroke and 81% male. Their mean±SD FM was 24.6±3.7 and gait speed was 0.74±0.38 m/s. For both TA and Gastroc, paretic MEP max were significantly smaller than non-paretic (p=3.8e -18 ). For Gastroc, higher ratio of paretic/non-paretic MEP max correlated with lesser impairment measured with FM (r=0.42, p=0.027). For TA, the correlation was lower and did not reach statistical significance (r=0.33, p=0.088). Gait speed did not have a significant correlation with MEP max . FM moderately correlated with gait speed (r=0.44, p=0.02). Conclusion: Gastroc MEP might be a better biomarker of motor impairment than TA. Thus, CMI to TA and Gastroc may provide different information in elucidating the mechanism of lower limb motor control. Gait speed does not correlate with CMI for dorsi-/plantarflexors which suggests that motor control of ambulation (gait speed) may differ from that of isolated joint movement (FM).

Gait Recovery Characteristic According to the Injury Aspect of Descending Motor Pathway in a Chronic Stroke Patient: a Case Study

Gait Recovery Characteristic According to the Injury Aspect of Descending Motor Pathway in a Chronic Stroke Patient: a Case Study

Gait asymmetry in stroke patients with unilateral spatial neglect

The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features.

Reliability of a Global Gait Symmetry Index Based on Linear Joint Displacements

Gait symmetry is commonly used as an informal measure to assess functional gait recovery. As other outcome measures used for the evaluation of clinical change over time, gait symmetry indices must be reliable. However, studies assessing the reliability of symmetry indices are scarce and focused on discrete and local indices (i.e., peak joint angle, step length), which fail to assess overall gait symmetry. On the other hand, the repeatability of global symmetry indices (using multiple continuous waveforms) based on joint angles may be hampered by the sensitivity of these variables to marker placement imprecision. The aim of this study is to evaluate the test–retest intra-rater reliability and measurement error of an alternative global symmetry index. Two 3D gait analyses were performed on separate days (a week interval) on twenty-three healthy adults. Reliability and measurement error were assessed by calculating the intraclass correlation coefficient and the 95% limits of agreement, standard error of measurement and smallest detectable change, respectively. The new symmetry index presented acceptable results in terms of reliability (ICC = 0.71, 95% CI 0.33–0.88) and measurement error (95% LOA between −30.2% and 29.1%, SEM = 10.7% and SDC = 29.7%), thus being a more promising tool to assess overall gait symmetry.

Randomized Controlled Trial of Robot-Assisted Gait Training versus Therapist-Assisted Treadmill Gait Training as Add-on Therapy in Early Subacute Stroke Patients: The GAITFAST Study Protocol.

The GAITFAST study (gait recovery in patients after acute ischemic stroke) aims to compare the effects of treadmill-based robot-assisted gait training (RTGT) and therapist-assisted treadmill gait training (TTGT) added to conventional physical therapy in first-ever ischemic stroke patients. GAITFAST (Clinicaltrials.gov identifier: NCT04824482) was designed as a single-blind single-center prospective randomized clinical trial with two parallel groups and a primary endpoint of gait speed recovery up to 6 months after ischemic stroke. A total of 120 eligible and enrolled participants will be randomly allocated (1:1) in TTGT or RTGT. All enrolled patients will undergo a 2-week intensive inpatient rehabilitation including TTGT or RTGT followed by four clinical assessments (at the beginning of inpatient rehabilitation 8-15 days after stroke onset, after 2 weeks, and 3 and 6 months after the first assessment). Every clinical assessment will include the assessment of gait speed and walking dependency, fMRI activation measures, neurological and sensorimotor impairments, and gait biomechanics. In a random selection (1:2) of the 120 enrolled patients, multimodal magnetic resonance imaging (MRI) data will be acquired and analyzed. This study will provide insight into the mechanisms behind poststroke gait behavioral changes resulting from intensive rehabilitation including assisted gait training (RTGT or TTGT) in early subacute IS patients.

The Time Course of MHC-I Expression in C57BL/6J and A/J Mice Correlates with the Degree of Retrograde Gliosis in the Spinal Cord following Sciatic Nerve Crush.

The pleiotropic role of the major histocompatibility complex class I (MHC-I) reflects the close association between the nervous and immune systems. In turn, MHC-I upregulation postinjury is associated with a better regenerative outcome in isogenic mice following peripheral nerve damage. In the present work, we compared the time course of neuronal, glial, and sensorimotor recovery (1, 3, 5, 7, and 28 days after lesion—dal) following unilateral sciatic nerve crush in A/J and C57BL/6J mice. The A/J strain showed higher expression of MHC-I (7 dal, ** p < 0.01), Iba-1 (microglial reaction, 7 dal, *** p < 0.001), and GFAP (astrogliosis, 5 dal, * p < 0.05) than the C57BL/6J counterpart. Synaptic coverage (synaptophysin) was equivalent in both strains over time. In addition, mRNA expression of microdissected spinal motoneurons revealed an increase in cytoskeleton-associated molecules (cofilin, shp2, and crmp2, * p < 0.05), but not trkB, in C57BL/6J mice. Gait recovery, studied by the sciatic functional index, was faster in the A/J strain, despite the equivalent results of C57BL/6J at 28 days after injury. A similar recovery was also seen for the nociceptive threshold (von Frey test). Interestingly, when evaluating proprioceptive recovery, C57BL/6J animals showed an enlarged base of support, indicating abnormal ambulation postinjury. Overall, the present results reinforce the role of MHC-I expression in the plasticity of the nervous system following axotomy, which in turn correlates with the variable recovery capacity among strains of mice.

A protocol to analyze the global literature on the clinical benefit of interlimb-coordinated intervention in gait recovery and the associated neurophysiological changes in patients with stroke.

Stroke is among the leading causes of disability of worldwide. Gait dysfunction is common in stroke survivors, and substantial advance is yet to be made in stroke rehabilitation practice to improve the clinical outcome of gait recovery. The role of the upper limb in gait recovery has been emphasized in the literature. Recent studies proposed that four limbs coordinated interventions, coined the term "interlimb-coordinated interventions," could promote gait function by increasing the neural coupling between the arms and legs. A high-quality review is essential to examine the clinical improvement and neurophysiological changes following interlimb-coordinated interventions in patients with stroke. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature will be retrieved from the databases of OVID, MEDLINE, PubMed, Web of Science, EMBASE, and PsycINFO. Studies published in English over the past 15 years will be included. All of the clinical studies (e.g., randomized, pseudorandomized and non-randomized controlled trials, uncontrolled trials, and case series) that employed interlimb intervention and assessed gait function of patients with stroke will be included. Clinical functions of gait, balance, lower limb functions, and neurophysiologic changes are the outcome measures of interest. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3. The findings of this study will provide insight into the clinical benefits and the neurophysiological adaptations of the nervous system induced by interlimb-coordinated intervention in patients with stroke. This would guide clinical decision-making and the future development of targeted neurorehabilitation protocol in stroke rehabilitation to improve gait and motor function in patients with stroke. Increasing neuroplasticity through four-limb intervention might complement therapeutic rehabilitation strategies in this patient group. The findings could also be insightful for other cerebral diseases.

Tendon progenitor cells as biological augmentation improve functional gait and reduce scar formation after rotator cuff repair

High rates of structural failure are reported after rotator cuff repairs due to inability to recreate the native enthesis during healing. The development of biological augmentation methods that mitigate scar formation and regenerate the enthesis is still an unmet need. Since neonatal enthesis is capable of regeneration after injury, this study tested whether delivery of neonatal tendon progenitor cells (TPCs) into the adult injured environment can enhance functional and structural supraspinatus enthesis and tendon healing. TPCs were isolated from Ai14 Rosa26-TdTomato mouse Achilles tendons and labeled using adenovirus-Cre. Fifty-two CB57BL/6J mice underwent detachment and acute repair of the supraspinatus tendon and received either a fibrin-only or TPC-fibrin gel. Immunofluorescence analysis was carried out to determine cellularity (DAPI), fibrocartilage (SOX9), macrophages (F4/80), myofibroblasts (α-smooth muscle actin), and scar (laminin). Assays for function (gait and biomechanical testing) and structure (micro-computed tomography imaging, picrosirius red/Alcian Blue staining, type I and III collagen staining) were carried out. Analysis of TdTomato cells after injury showed minimal retention of TPCs by day 7 and day 14, with detected cells localized near the bursa and deltoid rather than the enthesis/tendon. However, TPC delivery led to significantly increased %Sox9+ cells in the enthesis at day 7 after injury and decreased laminin intensity across almost all time points compared to fibrin-only treatment. Similarly, TPC-treated mice showed gait recovery by day 14 (paw area and stride length) and day 28 (stance time), while fibrin-treated mice failed to recover gait parameters. Despite improved gait, biomechanical testing showed no differences between groups. Structural analysis by micro-computed tomography suggests that TPC application improves cortical thickness after surgery compared to fibrin. Superior collagen alignment at the neo-enthesis was also observed in the TPC-augmented group at day 28, but no difference was detected in type I and III collagen intensity. We found that neonatal TPCs improved and restored functional gait by reducing overall scar formation, improving enthesis collagen alignment, and altering bony composition response after supraspinatus tendon repair. TPCs did not appear to integrate into the healing tissue, suggesting improved healing may be due to paracrine effects at early stages. Future work will determine the factors secreted by TPCs to develop translational targets.

Barriers to Gait Training among Stroke Survivors: An Integrative Review.

Gait recovery is vital for stroke survivors’ ability to perform their activities associated with daily living. Consequently, a gait impairment is a significant target for stroke survivors’ physical rehabilitation. This review aims to identify barriers to gait training among stroke survivors. An integrative review was conducted following Whittemore and Knafl’s methodology. The research was carried out on the electronic databases Scopus, PubMed, and B-on, applying a time span of 2006 to 2022. A total of 4189 articles were initially identified. After selecting and analyzing the articles, twelve studies were included in the sample. This review allowed for the identification of several barriers to gait training among stroke survivors, which can be grouped into three categories: individual, environmental, and rehabilitation workforce-related barriers. These findings highlight that participation in gait training is not solely dependent on the stroke survivor. Instead, the uptake of rehabilitation programs may also depend on environmental and rehabilitation workforce-related factors.

Upper limb movement during locomotion in patients with neurological disorders: a wearable-based approach

The contribution of upper limbs during walking is crucial in maintaining balance and stability: humans, in fact, swing each upper limb in phase with contra-lateral lower limb at their comfortable walking speed, with a ratio of 1:1 [1], thus counteracting the angular momentum, reducing the energy expenditure, and improving the overall gait efficiency [2,3]. In people who suffer from neurological disorders, like Multiple Sclerosis (MS) or Traumatic Brain Injury (TBI), upper limb function is often impaired, resulting in differences in arm swing frequency, amplitude, symmetry, as well as in the ratio between step and arm swing frequency, compared to healthy people [2]. Although it is known that a neurological rehabilitation program should focus on the recovery of a proper gait also emphasizing the contribution of upper limbs [1], few studies analyzed the contribution of the upper arms during locomotion in people with neurological disorders. The aim of this study is to explore a wearable sensor-based protocol for the assessment of the upper limb movement in patients with MS and TBI compared to healthy participants. Thirty-three patients suffering from MS (24 F; 49.8±9.3 y; EDSS 4.0±1.6), 8 patients suffering from TBI (2 F; 32.3±14.1 y; DGI 18.3±5.9), and 20 healthy adults (HC) (9 F; 37.0±19.9 y) were enrolled in this study (CE/PROG.700). Each participant performed a 10-meter Walking Test (10mWT) while wearing 5 synchronized inertial measurement units (IMUs) located at sternum, both wrists and distal tibiae level. Stride segmentation was performed using tibiae-mounted IMUs and the following parameters were estimated from wrist- and sternum-mounted IMUs [4]: arm oscillation frequency, peak and range of the angular velocity norm, as well as step to arm oscillation frequency ratio for the right (RW) and left (LW) wrists (freq, gyro peak, gyro range, Step-freq ratio). The range of the sternum cranio-caudal angular velocity was also obtained (sternum gyro range), together with a measure of symmetry (Symmetry Index [5]) between RW and LW angular velocity ranges. After checking for data normality, a one-way ANOVA was used to test for significant differences among MS, TBI, and HC. Post-hoc analysis was performed using Bonferroni-Holmes correction for multiple comparisons. Results are depicted in Fig. 1 (the larger the spider, the better the performance). Significant differences were found in frequency, symmetry, and angular velocity parameters among the MS, TBI, and HC. Patients with TBI seem to be characterized by a reduced performance with respect to MS, except for the step to arm swing ratio. The proposed assessment protocol demonstrates a potential clinical value in discriminating not only patients with neurological disorders from HC, but also patients with MS from TBI, who showed significant differences in terms of swing frequency, angular velocity range, and symmetry. This information could be useful in tailoring rehabilitation treatments involving the upper limbs during gait exercises [1]. Although in the present study, no significant difference was found among the three populations walking speed, the effect of the latter on the proposed metrics should be better investigated in further studies.

PC015 / #972 ONGOING CLINICAL TRIAL ASSESSING THE THERAPEUTIC POTENTIAL OF HIGH-DENSITY PREFRONTAL AND CEREBELLAR TRANSCRANIAL DIRECT CURRENT STIMULATION TO IMPROVE GAIT IN STROKE PATIENTS: E-POSTER VIEWING

Focal brain damage associated to stroke is the cause of large-scale network dysfunctions resulting in enduring motor sequels1. Transcranial direct current stimulation (tDCS) studies have shown promise in restoring local activity and network balance. Yet, clinical outcomes on complex functions such as gait remain inconsistent, highlighting the need to design and test innovative tDCS interventions2. To this regard, we here considered and assayed for the first time a dual-site multi-domain intervention approach based on the simultaneous modulation of two different set of systems (pre-frontal and cerebellar) both synergistically contributing to the recovery of gait after stroke3.

Evaluation of balance and gait in stroke patients: correlation between stabilometric indices and gait analysis parameters

Stroke is the leading cause of disability worldwide, with a significant individual, family and economic impact. Restoring balance and a more fluid, safe and correct gait is a prerequisite for the patient to recover autonomy in activities of daily life. Furthermore, a consequence of impaired gait recovery in stroke patients is the high risk of falls, which worsens their quality of life [1]. Since many falls are predictable, early identification of the risk of falls is crucial for developing tailored interventions to prevent such falls. Recently, an instrumental fall risk assessment index was developed using the Hunova® robotic platform (Silver Index - Movendo Technology, srl, Genoa, IT) with the aim of giving an early indication of this risk using numerical data of both static and dynamic balance [2]. In order to combine an instrumental assessment of balance and walking with a clinical evaluation, the aim of this study is to evaluate the correlation between the Silver Index and gait analysis parameters in order to be able to propose more personalized rehabilitation training. We enrolled 12 stroke patients, aged between 70 and 95 years. The risk of falls evaluation was performed by Hunova® robotic platform computing the Silver Index. The gait was analyzed by an optoelectronic system with 8 infrared cameras (SMART-DX500 – BTS Bioengineering, Milan, IT). We used the Davis protocol that includes 22 markers. For each patient we calculated the mean values as well as the coefficient of variation (CV) and the multiple correlation coefficient (CMC) of spatio-temporal parameters and joint kinematic parameters. We assessed CV and CMC to quantify variability of the discrete and continuous variables, respectively [3]. We used Spearman test to calculate the correlation between the Silver Index and the gait analysis parameters. The correlation analysis shows a statistically significant correlation between the Silver Index and the stance phase of the unaffected side (%) (p=0.036, ρ=0.700) and between the Silver Index and the swing phase of the unaffected side (%) (p=0.036, ρ=-0.700). Furthermore, the Silver Index correlates with the variability of step width (p=0.007, ρ=-0.816). These preliminary results show that the risk of falling is higher in patients who have a longer stance phase of the unaffected limb and a shorter duration of the swing phase always of the unaffected limb. Furthermore, our results show that patients who fall more have less variability in step width. This could be an indication that these patients are unable to make the continuous adjustments that occur physiologically during gait and thus fail to produce dynamic adaptation during walking.

Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures.

BackgroundInertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function.MethodsPROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score.ResultsGait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively.ConclusionSensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.

Multi-expert synthesis for versatile locomotion and manipulation skills.

This work focuses on generating multiple coordinated motor skills for intelligent systems and studies a Multi-Expert Synthesis (MES) approach to achieve versatile robotic skills for locomotion and manipulation. MES embeds and uses expert skills to solve new composite tasks, and is able to synthesise and coordinate different and multiple skills smoothly. We proposed essential and effective design guidelines for training successful MES policies in simulation, which were deployed on both floating- and fixed-base robots. We formulated new algorithms to systematically determine task-relevant state variables for each individual experts which improved robustness and learning efficiency, and an explicit enforcement objective to diversify skills among different experts. The capabilities of MES policies were validated in both simulation and real experiments for locomotion and bi-manual manipulation. We demonstrated that the MES policies achieved robust locomotion on the quadruped ANYmal by fusing the gait recovery and trotting skills. For object manipulation, the MES policies learned to first reconfigure an object in an ungraspable pose and then grasp it through cooperative dual-arm manipulation.

Corticospinal Excitability Quantification During a Visually-Guided Precision Walking Task in Humans: Potential for Neurorehabilitation

The corticospinal tract has been shown to be involved in normal walking in humans. However, its contribution during more challenging locomotor tasks is still unclear. As the corticospinal tract can be a potential target to promote gait recovery after neurological injury, it is of primary importance to quantify its use during human walking. The aims of the current study were to: (1) quantify the effects of precision walking on corticospinal excitability as compared to normal walking; (2) assess if corticospinal modulation is related to task difficulty or participants’ performance. Sixteen healthy participants walked on a treadmill during 2 tasks: regular walking (simple task) and stepping onto virtual targets (precision task). Virtual targets appeared randomly at 3 different step lengths: preferred, and ±20%. To assess corticospinal excitability, 25 motor evoked potentials (MEPs) were recorded from the tibialis anterior muscle in each task during walking. Performance for each participant (global success score; % of target hit) and task difficulty related to step length adjustments (success score for each step length) were also calculated. MEP size was larger during the precision task in all participants (mean increase of 93% ± 72%; P < .05) compared to the simple task. There was a correlation between MEP facilitation and individual performance (r = −.64; P < .05), but no difference in MEP size associated with task difficulty (P > .05). In conclusion, corticospinal excitability exhibits a large increase during the precision task. This effect needs to be confirmed in neurological populations to potentially provide a simple and non-invasive approach to increase corticospinal drive during gait rehabilitation.

Exercise on Striatal Dopamine Level and Anxiety-Like Behavior in Male Rats after 2-VO Cerebral Ischemia.

The purpose of this study was to discuss the effect of voluntary wheel running on striatal dopamine levels and anxiety-like behavior in rats with global cerebral ischemia. The male Sprague-Dawley rats were signed on in this study and randomly divided into following 4 groups: Control group (C group), Sham group (S group), ischemia group (I group), and 3 weeks physical exercise before ischemia group (3RI group). The rats in the 3RI group were placed in a voluntary running wheel for three weeks to exercise. Then, the rats in I and 3RI groups received bilateral carotid artery ligation (2-VO) operation. The C and S group did not perform voluntary running exercise and the bilateral common carotid arteries of S group were exposed without ligation. In vivo microdialysis was used in conjunction with high performance liquid chromatography (HPLC) and electrochemical detection to ascertain the level of dopamine in the striatum. Elevated plus maze (EPM) and open field (OF) were used to test anxiety status at 24 hours and 7days after 2-VO cerebral ischemia. Meanwhile, gait and motor coordination evaluations were carried out to eliminate the influence of non-specific motor problems. The results indicated that cerebral ischemia instigate the increase of striatal dopamine in I group rats during acute cerebral ischemia. A 3-week voluntary wheel running significantly enhances the striatal dopamine before ischemia and obstructs a further increase of dopamine during acute cerebral ischemia in 3RI group rats. At 24 hours after ischemia, striatal dopamine returned to pre-ischemic levels in 3RI group. Striatal dopamine in I group were less than pre-ischemic levels at 7 days. Behavioral data indicated that 3-week voluntary wheel running promoted recovery of anxiety-like behavior and gait were not affected by 2-VO cerebral ischemia at 24 hours post-ischemia rats. Therefore, it can be concluded that 3-week physical exercise significantly increased the striatal dopamine and improved anxiety-like behavior by inhibiting the increase of dopamine during acute cerebral ischemia and suppressing the decrease of dopamine after 24 hours and 7 days cerebral ischemia.

Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice.

Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.

Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial

ObjectiveTo investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. DesignA single-blinded randomized controlled trial. SettingGeneral community. ParticipantsThirty-four older adults (N=34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group [PUSH], n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). InterventionPUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. Main Outcome MeasuresGait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. ResultsAt 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%, 95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively. ConclusionGait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.

Adaptive Gait from the Neurorehabilitation Perspective

Recent studies have reported the neural mechanisms underlying gait and motor function recovery; neurorehabilitation involves application of these findings to clinical rehabilitation. This article focuses on post-stroke gait disorders. Gait disorder in patients with hemiplegic stroke is characterized by reduced walking speed, which is attributable to merged muscle synergies and a decreased trail limb angle. This paper describes the aforementioned factors and recent clinical research that confirms the role of the volume of gait as the most important factor, as well as evidence of various intervention methods. Furthermore, it is necessary to experience walking in various contexts and environments to achieve adaptive gait.