If something meaningful came out of this I couldn't understand it. The equipment needed to do this will never be purchased by your stroke hospital. They talk about 'potential' but nothing on 100% recovery.
Improved cortical activity and reduced gait asymmetry during poststroke self-paced walking rehabilitation
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 60 (2021)
Abstract
Background
For patients with gait impairment due to neurological disorders, body weight-supported treadmill training (BWSTT) has been widely used for gait rehabilitation. On a conventional (passive) treadmill that runs at a constant speed, however, the level of patient engagement and cortical activity decreased compared with gait training on the ground. To increase the level of cognitive engagement and brain activity during gait rehabilitation, a self-paced (active) treadmill is introduced to allow patients to actively control walking speed, as with overground walking.
Methods
To validate the effects of self-paced treadmill walking on cortical activities, this paper presents a clinical test with stroke survivors. We hypothesized that cortical activities on the affected side of the brain would also increase during active walking because patients have to match the target walking speed with the affected lower limbs. Thus, asymmetric gait patterns such as limping or hobbling might also decrease during active walking.
Results
Although the clinical test was conducted in a short period, the patients showed higher cognitive engagement, improved brain activities assessed by electroencephalography (EEG), and decreased gait asymmetry with the self-paced treadmill. As expected, increases in the spectral power of the low γ and β bands in the prefrontal cortex (PFC), premotor cortex (PMC), and supramarginal gyrus (SG) were found, which are possibly related to processing sensory data and planning voluntary movements. In addition, these changes in cortical activities were also found with the affected lower limbs during the swing phase. Since our treadmill controller tracked the swing speed of the leg to control walking speed, such results imply that subjects made substantial effort to control their affected legs in the swing phase to match the target walking speed.
Conclusions
The patients also showed reduced gait asymmetry patterns. Based on the results, the self-paced gait training system has the potential to train the symmetric gait and to promote the related cortical activities after stroke.
Trial registration Not applicable
Background
Stroke is a prevalent disease caused by hemorrhagic or ischemic injury in the brain and accompanied by motor disability. Impaired motor function can be recovered to some extent by cortical reorganization [1]. Rehabilitation within the first 3 months after stroke is essential to promote recovery by neural plasticity [2]. The restoration of locomotor function is a major issue in rehabilitation for many patients affected by stroke since gait disorders limit performing social and daily living activities [3]. In addition, the risk of falls that could cause traumatic injury increases as gait performance decreases [4]. Thus, in the hospital and afterwards, gait rehabilitation is provided for stroke survivors to improve their walking performance [5, 6].
Body weight-supported treadmill training (BWSTT) is widely performed for gait rehabilitation since it provides safe and repeatable training in small spaces with less burden on the therapist compared with overground training. However, there is a study showing that the effect of training on a treadmill was not superior to that of overground training with a therapist [7]. On the conventional treadmill, patients have difficulties voluntarily participating and engaging in training because they adapt to the unchanging speed. To overcome this limitation of the traditional treadmill, a self-paced treadmill that simulates overground walking was developed [8,9,10,11], and sometimes with a virtual reality system [12, 13] for gait rehabilitation after neurological disorders [10, 12, 13]. The speed of the treadmill belt is controlled by preferences of a user by measuring the position of the user’s body segments [11, 14] using a commercial depth sensor [15] or using a motion capture system [16]. In addition, unexpected inertial force by sudden acceleration and deceleration was modified by the velocity of the swing foot [9].
Several studies reported differences in a variability of spatiotemporal gait parameters between the self-paced treadmill walking and the conventional treadmill walking with a fixed speed. A larger variability of stride length and stride time was found with the self-paced treadmill than the conventional treadmill in neurologically intact human subjects [17, 18]. When a control algorithm of the self-paced treadmill is adjusted to be more sensitive to a user’s movement, larger variabilities of these gait parameters are found [19]. In addition, such spatiotemporal gait parameters on self-paced treadmill can be effectively used for Multiple Sclerosis prediction [20]. As far as the authors know, however, it remains unclear how the self-paced treadmill walking affects cortical activities in patients after neurological disorders.
Monitoring the brain activity of the patient is helpful in identifying the effect of training and suggests an effective gait rehabilitation approach since impaired function could be recovered by cortical reorganization [21]. Several studies have shown that the function and structure in the regions adjacent to the impaired area after stroke, as well as regions remote from the cortical lesion, were changed during the recovery process by brain plasticity [22]. In addition to the voluntary recovery of lost function during the initial several months after stroke, therapy-induced neural reorganization could promote recovery [23, 24].
There are several noninvasive neuroimaging techniques to monitor cortical activity, such as fMRI, fNIRS, and EEG. Functional magnetic resonance imaging (fMRI) is widely used to elucidate brain activation due to its high spatial resolution. Although the activity in the brain, including deep brain tissue and the cerebral cortex, can be monitored by fMRI, this neuroimaging technology is not suitable to study cortical activity during dynamic walking since the subject has to remain in the lying position in a static state before or after the intervention [25]. To monitor cortical activity during dynamic activities, functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) are suitable to examine cortical changes during walking. Increased oxygenated hemoglobin (oxyHb) in sensorimotor cortices and supplementary cortex was monitored using fNIRS during walking [26, 27]. In another study, activation in the prefrontal, premotor and sensorimotor cortex was reported to increase while walking [28]. During precise stepping, increased oxyHb in the prefrontal and supplementary motor cortex was observed in another study [29]. In research with participants performing a dual task during walking, a change in activity in the prefrontal cortex related to cognitive performance was observed [30].
Although EEG recording has a low spatial resolution, intra-stride characteristics could be identified due to its high temporal resolution. Previous studies have reported that spectral power decreased in the
band was demonstrated during active walking [33]. EEG can also be used to demonstrate effective connectivity by calculating Granger causality [34, 35]. In one study, connectivity between motor areas and others decreased, but connectivity between nonmotor areas increased during steady walking compared to standing [36].
In this study, we used a similar experimental protocol as that used with healthy subjects in the previous study to extend the analysis to stroke survivors [33]. Brain activity levels were monitored and compared between the self-paced treadmill and conventional treadmill with the fixed walking speed using EEG recording. We hypothesized that active walking on the self-paced treadmill allows patients to engage more in the training and to increase cortical activity than walking at a fixed speed. In addition, gait asymmetry patterns might decrease during active walking, as target walking speed is actively maintained, compared to passive walking conditions.
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