Totally useless. ABSOLUTELY NOTHING HERE OBJECTIVELY HELPS RECOVERY. Describing problems in stroke is useless without solutions. And your mentors and senior researchers approved this crapola?
Brain activity during real-time walking and with walking interventions after stroke: a systematic review
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 8 (2021)
Abstract
Investigations of real-time brain activations during walking have become increasingly important to aid in recovery of walking after a stroke. Individual brain activation patterns can be a valuable biomarker of neuroplasticity during the rehabilitation process and can result in improved personalized medicine for rehabilitation. The purpose of this systematic review is to explore the brain activation characteristics during walking post-stroke by determining: (1) if different components of gait (i.e., initiation/acceleration, steady-state, complex) result in different brain activations, (2) whether brain activations differ from healthy individuals. Six databases were searched resulting in 22 studies. Initiation/acceleration showed bilateral activation in frontal areas; steady-state and complex walking showed broad activations with the majority exploring and finding increases in frontal regions and some studies also showing increases in parietal activation. Asymmetrical activations were often related to performance asymmetry and were more common in studies with slower gait speed. Hyperactivations and asymmetrical activations commonly decreased with walking interventions and as walking performance improved. Hyperactivations often persisted in individuals who had experienced severe strokes. Only a third of the studies included comparisons to a healthy group: individuals post-stroke employed greater brain activation compared to young adults, while comparisons to older adults were less clear and limited. Current literature suggests some indicators of walking recovery however future studies investigating more brain regions and comparisons with healthy age-matched adults are needed to further understand the effect of stroke on walking-related brain activation.
Background
Stroke is a leading cause of adult long-term disability worldwide. The restoration of gait is rated as a high priority for stroke survivors [1, 2]. Yet, more than 50% of individuals living post-stroke do not independently walk within their community [3, 4]. Arguably, the efficacy of gait rehabilitation could be advanced with an individual’s personal brain activations [5, 6]. This notion of personalized medicine has become an important avenue of exploration and is now stated as a research priority within national funding agencies [7]. Determining neural correlates of walking is an important starting point in investigating how brain activation can be a valuable biomarker or indicator of neuroplasticity during the rehabilitation process.
Until recently, neural correlates of human walking were informed by studies with simulated or imagined walking tasks while under constrained brain imaging environments. The recent advancement in technologies such as portable electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and radioactive tracing with positron emission topography (PET) or single-photon emission computerized tomography (SPECT) have allowed for investigation of brain function during real-time walking. Comparisons of simulated/imagined walking and real-time walking in healthy adults show many similarities in activation areas along the cortex, basal ganglia, brainstem, and cerebellum [8] and differences in motor preparatory areas (e.g., bilateral supplementary motor area (SMA)) and executive function areas (e.g., dorsolateral prefrontal cortex (PFC)) [9].
The ability to obtain measurements during real-time walking allows for investigation of brain activations associated with walking components that are necessary for successful community ambulation, such as acceleration/deceleration phases, steady-state walking, and complex situations that involve avoiding obstacles or doing multiple tasks at once (e.g., talking and walking). Previous studies show differing brain activities during these various components. In healthy adults, walking preparation increases PFC, premotor cortex (PMC), SMA and medial sensorimotor cortex (SMC) activity, whereas walking execution mainly activates SMA and medial SMC [10]. As the complexity of walking increases (e.g., walking while doing a secondary task), further increases of bilateral PFC activation are shown in healthy older adults [11]. When assessing brain activation during different components of walking within neurological populations, results are quite varied [12,13,14]. Other reviews investigating brain activation during real-time walking focus on the general neurological population category, rather than stroke specifically [8, 15]. Two systematic reviews exclusively looking at fNIRS studies in individuals with stroke only included three and five real-time walking studies [16, 17]. Their narrow inclusion criteria excluded some pertinent studies and more investigations have since been conducted in the stroke population. To facilitate rehabilitation of community ambulation post-stroke, a thorough understanding of how stroke affects functional brain activation during various walking components is necessary.
Thus, the purpose of the current systematic review is to consolidate work investigating the spatial and temporal brain activation of real-time walking in individuals with stroke. Specifically, studies will be described within three components:
-
1.
Intention/acceleration: prior to walking onset or immediately post initiation of walking
-
2.
Steady-state: during walking at a steady pace without additional tasks
-
3.
Complex walking: walking with a secondary task or an externally cued gait
No comments:
Post a Comment