Noninvasive Neuromodulation in Poststroke Gait Disorders Rationale, Feasibility, and State of the Art

My post stroke walking disturbance is strictly from spasticity. I can't tell from this if spasticity was accounted for or tested.
http://nnr.sagepub.com/content/30/1/71?etoc

1. Raffaella Chieffo, MD, PhD1⇑
2. Giancarlo Comi, MD1
3. Letizia Leocani, MD, PhD1

1. ¹Scientific Institute Vita-Salute University San Raffaele, Milan, Italy

1. Raffaella Chieffo, MD, PhD, Neurological Department and Institute of Experimental Neurology—INSPE, Scientific Institute Hospital San Raffaele, Via Olgettina 48, 20133 Milan, Italy. Email: raffaella.chieffo@hsr.it

Abstract

Walking rehabilitation is one of the primary goals in stroke survivors because of its great potential for recovery and its functional relevance in daily living activities. Although 70% to 80% of people in the chronic poststroke phases are able to walk, impairment of gait often persists, involving speed, endurance, and stability. Walking involves several brain regions, such as the sensorimotor cortex, supplementary motor area, cerebellum, and brainstem, which are approachable by the application of noninvasive brain stimulation (NIBS). NIBS techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been reported to modulate neural activity beyond the period of stimulation, facilitating neuroplasticity. NIBS methods have been largely applied for improving paretic hand motor function and stroke-associated cognitive deficits. Recent studies suggest a possible effectiveness of these techniques also in the recovery of poststroke gait disturbance. This article is a selective review about functional investigations addressing the mechanisms of lower-limb motor system reorganization after stroke and the application of NIBS for neurorehabilitation.