Motor Cortex and Motor Cortical Interhemispheric Communication in Walking After Stroke

So our doctors and therapists have little understanding of impaired walking. Every single stroke survivor in the world is a guinea pig in uncontrolled research. Hopefully your doctor gets some updates to your stroke walking protocol from this.
http://nnr.sagepub.com/content/30/1/94?etoc

The Roles of Transcranial Magnetic Stimulation and Animal Models in Our Current and Future Understanding

1. Charalambos C. Charalambous, MS1
2. Mark G. Bowden, PhD1,2
3. DeAnna L. Adkins, PhD1,3⇑

1. ¹Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
2. ²Ralph H. Johnson VA Medical Center, Charleston, SC, USA
3. ³Department of Neurosciences, Medical University of South Carolina, Charleston, SC

1. DeAnna L. Adkins, Department of Neurosciences, Medical University of South Carolina, 173 Ashley Avenue, CRI404D, MSC 510, Charleston, SC 29425-7000, USA. Email: adkinsdl@musc.edu

Abstract

Despite the plethora of human neurophysiological research, the bilateral involvement of the leg motor cortical areas and their interhemispheric interaction during both normal and impaired human walking is poorly understood. Using transcranial magnetic stimulation (TMS), we have expanded our understanding of the role upper-extremity motor cortical areas play in normal movements and how stroke alters this role, and probed the efficacy of interventions to improve post-stroke arm function. However, similar investigations of the legs have lagged behind, in part, due to the anatomical difficulty in using TMS to stimulate the leg motor cortical areas. Additionally, leg movements are predominately bilaterally controlled and require interlimb coordination that may involve both hemispheres. The sensitive, but invasive, tools used in animal models of locomotion hold great potential for increasing our understanding of the bihemispheric motor cortical control of walking. In this review, we discuss 3 themes associated with the bihemispheric motor cortical control of walking after stroke: (a) what is known about the role of the bihemispheric motor cortical control in healthy and poststroke leg movements, (b) how the neural remodeling of the contralesional hemisphere can affect walking recovery after a stroke, and (c) what is the effect of behavioral rehabilitation training of walking on the neural remodeling of the motor cortical areas bilaterally. For each theme, we discuss how rodent models can enhance the present knowledge on human walking by testing hypotheses that cannot be investigated in humans, and how these findings can then be back-translated into the neurorehabilitation of poststroke walking.