Deans' stroke musings: Absence of a Transcranial Magnetic Stimulation–Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, August 20, 2018

Absence of a Transcranial Magnetic Stimulation–Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors

I got absolutely nothing out of this.
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021718?platform=hootsuite

Anjali Sivaramakrishnan

and

Sangeetha Madhavan

Originally published9 Jul 2018Stroke. 2018;49:2004-2007

Abstract

Background and Purpose—

Transcranial magnetic stimulation is used to measure the functional integrity of the corticomotor system via motor evoked potentials (MEPs) in stroke. The association between corticomotor mechanisms and walking recovery is still not completely understood. This study determined the association between transcranial magnetic stimulation–induced MEPs and walking outcomes and examined the contribution of the contralesional hemisphere to walking recovery.

Methods—

Contralateral and ipsilateral transcranial magnetic stimulation responses from the contralesional and ipsilesional hemispheres were collected from 61 chronic stroke survivors. Clinical assessments included gait speeds, 6-minute walk distance, Timed Up and Go test, Fugl Meyer lower extremity scale, and strength measurements.

Results—

Stroke participants were classified based on the presence (MEP+ [n=28]) or absence (MEP− [n=33]) of MEPs in the paretic tibialis anterior and rectus femoris muscles. A between-group analyses showed no significant differences for any gait variable. MEP+ group showed significantly higher Fugl Meyer lower extremity and ankle dorsiflexor strength. Ipsilateral conductivity was not significantly different between groups. Finally, in the MEP+ group, MEP parameters did not predict gait recovery.

Conclusions—

Our study investigated the association between walking outcomes and neurophysiological parameters of lower limb function in a large cohort of stroke survivors. We did not find an associations between transcranial magnetic stimulation–induced tibialis anterior and rectus femoris MEPs and walking speeds. Further work is required to develop more comprehensive models in stroke for predicting walking recovery.

Introduction

Regaining the ability to walk independently is an important functional goal for stroke survivors. Gait speed is an important determinant of walking recovery, and descending corticomotor control is a significant contributor to gait recovery poststroke¹ Several studies have shown that the presence or absence of a transcranial magnetic stimulation (TMS)–induced motor evoked potential (MEP) is related to upper limb functional recovery in acute and chronic stroke.² For the lower limb (LL), few studies suggest that absent MEP responses may be associated with greater walking difficulty.^3,4 However, the relationship of the MEP to gait speed and other measures of LL function still needs to be elucidated. In addition, there remains a large gap in our understanding of the adaptive or maladaptive nature of the contralesional hemisphere and its contribution to walking recovery. Few LL stroke studies have shown that greater ipsilateral drive from the contralesional hemisphere is associated with greater LL impairment and reduced performance in a skilled motor task.^5,6 Whether this increased ipsilateral drive also affects walking speed is still unknown.
Identification of MEP as a neurophysiological biomarker for walking recovery has the potential to effectively tailor neuromodulation-related treatments and other therapies. In this study, our primary aim was to determine whether LL functional corticospinal tract integrity, determined by the presence or absence of tibialis anterior (TA) and rectus femoris (RF) MEPs, was associated with gait speeds in chronic stroke. We also examined the relationship between ipsilateral connectivity from the contralesional M1 to the paretic LL muscles and its association to walking recovery.

More at link.