https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021718?platform=hootsuite
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.
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