Partial body weight-supported treadmill training for gait restoration in hemiplegic patients: evaluation of using motor evoked potentials

ABSTRACT

Partial body weight support treadmill training [PBWST] is a task-oriented gait rehabilitation protocol for hemiplegic/paretic patients with proven clinical efficiency. At the neurophysiologic level, motor-evoked potentials [MEP] induced by transcranial magnetic stimulation [TMS] and recorded from target lower limb muscles may be used to assess the post-rehabilitation effects. Assessment of the effects of PBWST on the MEPs recorded from target lower limb muscles in chronic post-stroke hemiparetics. Thirty patients with post-stroke chronic hemiparesis were randomly allocated to one of 2 groups; PBWST group and conventional rehabilitation group. Initial evaluation included recording the MEP parameters from the quadriceps, tibialis anterior and gastrocnemius muscles. In addition, functional assessment tools included Fugel-Meyer assessment [FMA], functional ambulation category as well as Standing Balance Test. Endpoint evaluation using the same methods were obtained by the completion of 8 weeks of rehabilitation at a frequency of 3 times a week. Both study groups have shown significant post rehabilitation improvement of most of the recorded MEP parameters. The magnitude of post-rehabilitation change in the PBWST group was generally larger than in the other group. Significant correlation was observed between some parameters of the MEPs and the isolated movement subset of the FMA of both groups. Post-rehabilitation tibialis anterior latency was a significant predictor of post-rehabilitation co-ordination subset of the FMA in PBWST group. Pre- and post-rehabilitation latency and amplitude of the quadriceps MEP were significant predictor of the co-ordination subset of the FMA in the conventional rehabilitation group. MEPs parameters can monitor rehabilitation effects of PBWST at the neurophysiological level. The magnitude of PBWST post-rehabilitation effects was generally higher. MEP parameters can be used as predictors of functional outcome: