Neural Regeneration Research ›› 2015, Vol. 10 ›› Issue (12): 2072-2080.doi: 10.4103/1673-5374.172329

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Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation

Yi Xu1, 2, 3, Qing-hua Hou4, Shawn D. Russell3, Bradford C. Bennett5, Andrew J. Sellers6, Qiang Lin1, 2, Dong-feng Huang1, 2, *   

  1. 1 Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    2 Guangdong Provincial Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, Guangzhou, Guangdong Province, China
    3 Motion Analysis and Motor Performance Laboratory, Department of Orthopedics and Mechanical Engineering, University of Virginia,
    Charlottesville, VA, USA
    4 Department of Neurology, Guangdong No.2 Provincial People’s Hospital, Guangzhou, Guangdong Province, China
    5 H.C Sweere Center for Clinical Biomechanics and Applied Ergonomics, Northwestern Health Science University, Bloomington, MN, USA
    6 Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
  • Received:2015-03-28 Online:2015-12-30 Published:2015-12-30
  • Contact: Dong-feng Huang, M.D., huangdf_sysu@163.com.
  • Supported by:

    This work was supported by the National Natural Science Foundation of China, No. 30973165, 81372108, and a grant from Clinical Research 5010 Program Mission Statement of Sun Yat-Sen University, China, No. 2014001.

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Abstract:

Gait disorders drastically affect the quality of life of stroke survivors, making post-stroke rehabilitation an important research focus. Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment. However, a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized. We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery, and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery. While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity, it evolves over time, is idiosyncratic, and may develop maladaptive elements. Furthermore, noninvasive brain stimulation has limited reach capability and is facilitative-only in nature. Therefore, we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques.Additionally, when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors, stimulation montages should be customized according to the specific types of neuroplasticity found in each individual. This could be done using multiple mapping techniques.

Key words: nerve regeneration, stroke, cerebrovascular disorders, transcranial magnetic stimulation, neuroplasticity, transcranial direct current stimulation, electrical stimulation therapy, gait, walking, gait disorders, rehabilitation, neural regeneration