Motor Cortical Network Flexibility is Associated With Biomechanical Walking Impairment in Chronic Stroke.
Jacqueline A Palmer, Trisha M Kesar, Steven L Wolf and 1 others
PMID 34570636WHAT IT FOUND
People with chronic stroke had less flexible lower-limb brain network responses than controls.
More flexible responses were linked to better push-off from the paretic ankle during walking. This was a small research finding, not a tested treatment.
Key findings
01Stroke survivors showed blunted lower-limb motor cortical network reactivity to brain stimulation compared with controls at rest.
02In stroke survivors, lower-limb cortical network reactivity and activity-dependent modulation were associated with greater paretic ankle plantarflexion moment during walking.
03Most stroke survivors without a paretic leg motor evoked potential did not show increased cortical beta coherence after stimulation over the stroke-side motor cortex.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 12 of 14 stroke participants and 8 of 9 controls had complete EEG data for analysis. The optional clinical and biomechanical walking assessment was completed by 11 of 14 stroke participants. Participants had to be able to walk 10 meters without another person's assistance, so findings may not apply to people who cannot walk. Hemorrhagic stroke and direct lesion involvement of the medial precentral gyrus or corpus callosum were excluded. The sample was small and heterogeneous, and the authors could not stratify results by lesion or demographic characteristics. TMS intensity was not standardized for participants without paretic leg motor evoked potentials, requiring a non-standard approach. Handrail use during treadmill walking could affect ground reaction forces and kinematics, especially for more impaired participants. The researchers could not rule out that stimulation activated both motor cortices because lower-limb areas are close together.
Declared interests
The supplied text does not include a funding or conflict-of-interest declaration. The article types indicate NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that TMS-EEG is a clinical tool or that improving cortical network flexibility will improve walking. This was a small observational study that measured associations, not a treatment trial.