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. 2020 Apr;44(2):164-172.
doi: 10.1097/NPT.0000000000000311.

Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series

Sue Peters  1 , Tanya D Ivanova, Bimal Lakhani, Lara A Boyd, S Jayne Garland
Affiliations

Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series

Sue Peters et al. J Neurol Phys Ther. 2020 Apr.

Abstract

Background and purpose: Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping.

Case description: Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor.

Intervention: Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training).

Outcomes: All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude.

Discussion: Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).

Trial registration: ClinicalTrials.gov NCT01573585.

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