Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients

• Main Authors: Enas M Shahine, Tarek S Shafshak
• Format: Article
• Language: English
• Published: SpringerOpen 2014-01-01
• Series: Egyptian Rheumatology and Rehabilitation
• Subjects: locomotor training, motor evoked potential, neuroplasticity, treadmill with partial body weight support
• Online Access: http://www.err.eg.net/article.asp?issn=1110-161X;year=2014;volume=41;issue=3;spage=85;epage=91;aulast=Shahine
• ISSN: 1110-161X; 2090-3235

Objective To evaluate the efficacy of electromechanical gait training (EGT) versus treadmill training with partial body weight support (TTPBWS) on lower limb motor performance (MP) and on motor evoked potential (MEP) in patients with chronic stroke. Patients and methods Fifty patients (age 43-75 years) with hemiparetic stroke (7-72 months′ duration) were allocated randomly to two groups. Patients of group I (n = 25) received EGT and those of group II (n = 25) received TTPBWS (20 min/day, 6 days/week for 8 weeks). Main outcome measurements: Fugel-Meyer lower extremity (FMLE) MP test and MEP were assessed in all patients before rehabilitation (A-begin), at the end of rehabilitation (A-end), and 3 months later (A-3m). By transcranial magnetic stimulation, MEP threshold, MEP amplitude (MEPamp), and cortical latencies to the rectus femoris, tibialis anterior, and gastrocnemius (GC) muscles were assessed. Results Better improvement in FMLE was observed in group I compared with group II. In group I, FMLE scores improved significantly at A-3m compared with A-end. A significant reduction in GC cortical latencies and increase in GC MEPamp on the second and third follow-up were observed in group I compared with group II. Although all MEP parameters of the three lower limb muscles tested improved throughout the follow-up periods on intragroup compression, they did not reach statistically significant levels. More patients in group I (unlike group II) with unobtainable MEP at A-begin had obtainable MEP at A-end and A-3m from rectus femoris and GC muscles. The change in MEPamp was the most frequent MEP variable that correlated with the change in FMLE scores (in either group). Conclusion Better improvement in MP was observed following EGT at A-3m. Therefore, one EGT rather than TTPBWS may be recommended to improve lower extremity MP in chronic ambulatory stroke patients.