Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial.
Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial.
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DOI：
10.1161/strokeaha.108.527531
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发表时间：
2008-12
期刊：
影响因子：
8.3
通讯作者：
Hanley DF
中科院分区：
文献类型：
--
作者：
Luft AR;Macko RF;Forrester LW;Villagra F;Ivey F;Sorkin JD;Whitall J;McCombe-Waller S;Katzel L;Goldberg AP;Hanley DF
中风常常损害步态，从而降低活动能力和健康水平，并导致慢性残疾。步态是一种复杂的感觉运动功能，由集成的皮质、皮质下和脊柱网络控制。中风后步态恢复的机制尚不清楚。本研究检验了这样的假设：渐进式任务重复跑步机运动 (T-EX) 通过诱导大脑适应（可塑性）来改善慢性偏瘫中风受试者的健康和步态功能。一项随机对照试验确定了 6 个月 T-EX (n=37) 与相当持续时间的拉伸 (CON, n=34) 对步行、有氧健身的影响，以及通过功能 MRI 测量的子集 (n=15/17) 对大脑激活的影响。 T-EX 显着提高了跑步机行走速度 51%，心血管健康水平提高了 18%（CON 分别为 11% 和 -3%；P<0.05）。 T-EX 但不影响瘫痪期间的大脑激活，但不影响非瘫痪肢体运动期间的大脑激活，显示小脑后叶激活增加 72%，中脑激活增加 18%（P<0.005）。运动介导的步行速度的改善与小脑和中脑的激活增加相关。 T-EX 可以改善步行、健身并招募小脑-中脑回路，这可能反映了神经网络的可塑性。这种神经募集与更好的行走有关。这些发现证明了 T-EX 康复在促进长期活动障碍的中风幸存者步态恢复方面的有效性，并提供了神经可塑性机制的证据，这些机制可能导致这些范例的进一步完善，以改善功能结果。
Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain (plasticity). A randomized controlled trial determined the effects of 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic fitness and in a subset (n=15/17) on brain activation measured by functional MRI. T-EX significantly improved treadmill-walking velocity by 51% and cardiovascular fitness by 18% (11% and −3% for CON, respectively; P<0.05). T-EX but not CON affected brain activation during paretic, but not during nonparetic limb movement, showing 72% increased activation in posterior cerebellar lobe and 18% in midbrain (P<0.005). Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain. T-EX improves walking, fitness and recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. This neural recruitment is associated with better walking. These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes.