Brain activity during real-time walking and with walking interventions after stroke: a systematic review.
Shannon B Lim, Dennis R Louie, Sue Peters and 3 others
PMID 33451346WHAT IT FOUND
Brain imaging during real-time walking in stroke survivors shows increased activity in motor and planning areas compared to standing, but findings vary widely by walking phase.
Activation patterns are inconsistent when compared to healthy adults, and no single brain region reliably predicts walking recovery.
Key findings
01Stroke survivors showed bilateral increases in prefrontal, supplementary motor, and sensorimotor cortex activation during walking compared to standing, with asymmetries appearing mainly during steady-state walking.
02Comparisons with healthy adults yielded inconsistent results; stroke groups often showed greater prefrontal activation than young adults but similar or variable activation compared to older adults, suggesting age may confound brain activation findings.
03Correlations between brain activation changes and gait performance were mixed; some studies linked increased sensorimotor symmetry to better gait symmetry, while others found no relationship between brain activity and walking speed or balance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Most studies had very small sample sizes, with 10 of 22 studies including fewer than 10 participants. There was significant heterogeneity in imaging methods (fNIRS, EEG, PET), brain regions of interest, and walking tasks, making direct comparisons difficult. Less than half of the studies included a healthy control group, making it hard to distinguish stroke-related brain changes from normal aging. The review included non-peer-reviewed sources like conference abstracts and book chapters to capture all available data, which may lower the overall quality of evidence. Details on how brain recording devices were placed on participants' heads were often missing or imprecise, potentially affecting the accuracy of localization.
Declared interests
The authors declared no competing interests. The study was supported by non-U.S. government funding sources.
The easy way to misread this
Do not interpret the observed brain activation changes as proof that specific interventions cause neuroplasticity or improve walking. The review found inconsistent results across studies, and many changes could be related to age or task complexity rather than stroke recovery mechanisms.