Post-stroke Hemiplegic Gait: New Perspective and Insights
Walking dysfunction occurs at a very high prevalence in stroke survivors. Human walking is a phenomenon often taken for granted, but it is mediated by complicated neural control mechanisms. The automatic process includes the brainstem descending pathways (RST and VST) and the intraspinal locomotor n...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-08-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2018.01021/full |
| _version_ | 1828494849891893248 |
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| author | Sheng Li Sheng Li Gerard E. Francisco Gerard E. Francisco Ping Zhou Ping Zhou Ping Zhou |
| author_facet | Sheng Li Sheng Li Gerard E. Francisco Gerard E. Francisco Ping Zhou Ping Zhou Ping Zhou |
| author_sort | Sheng Li |
| collection | DOAJ |
| description | Walking dysfunction occurs at a very high prevalence in stroke survivors. Human walking is a phenomenon often taken for granted, but it is mediated by complicated neural control mechanisms. The automatic process includes the brainstem descending pathways (RST and VST) and the intraspinal locomotor network. It is known that leg muscles are organized into modules to serve subtasks for body support, posture and locomotion. Major kinematic mechanisms are recognized to minimize the center of gravity (COG) displacement. Stroke leads to damage to motor cortices and their descending corticospinal tracts and subsequent muscle weakness. On the other hand, brainstem descending pathways and the intraspinal motor network are disinhibited and become hyperexcitable. Recent advances suggest that they mediate post-stroke spasticity and diffuse spastic synergistic activation. As a result of such changes, existing modules are simplified and merged, thus leading to poor body support and walking performance. The wide range and hierarchy of post-stroke hemiplegic gait impairments is a reflection of mechanical consequences of muscle weakness, spasticity, abnormal synergistic activation and their interactions. Given the role of brainstem descending pathways in body support and locomotion and post-stroke spasticity, a new perspective of understanding post-stroke hemiplegic gait is proposed. Its clinical implications for management of hemiplegic gait are discussed. Two cases are presented as clinical application examples. |
| first_indexed | 2024-12-11T12:03:03Z |
| format | Article |
| id | doaj.art-5895f2db88e840a3b2ae49ccbfa49da1 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-11T12:03:03Z |
| publishDate | 2018-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-5895f2db88e840a3b2ae49ccbfa49da12022-12-22T01:08:00ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2018-08-01910.3389/fphys.2018.01021389766Post-stroke Hemiplegic Gait: New Perspective and InsightsSheng Li0Sheng Li1Gerard E. Francisco2Gerard E. Francisco3Ping Zhou4Ping Zhou5Ping Zhou6Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United StatesTIRR Memorial Hermann Research Center, TIRR Memorial Hermann, Houston, TX, United StatesDepartment of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United StatesTIRR Memorial Hermann Research Center, TIRR Memorial Hermann, Houston, TX, United StatesDepartment of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United StatesTIRR Memorial Hermann Research Center, TIRR Memorial Hermann, Houston, TX, United StatesGuangdong Work Injury Rehabilitation Center, Guangzhou, ChinaWalking dysfunction occurs at a very high prevalence in stroke survivors. Human walking is a phenomenon often taken for granted, but it is mediated by complicated neural control mechanisms. The automatic process includes the brainstem descending pathways (RST and VST) and the intraspinal locomotor network. It is known that leg muscles are organized into modules to serve subtasks for body support, posture and locomotion. Major kinematic mechanisms are recognized to minimize the center of gravity (COG) displacement. Stroke leads to damage to motor cortices and their descending corticospinal tracts and subsequent muscle weakness. On the other hand, brainstem descending pathways and the intraspinal motor network are disinhibited and become hyperexcitable. Recent advances suggest that they mediate post-stroke spasticity and diffuse spastic synergistic activation. As a result of such changes, existing modules are simplified and merged, thus leading to poor body support and walking performance. The wide range and hierarchy of post-stroke hemiplegic gait impairments is a reflection of mechanical consequences of muscle weakness, spasticity, abnormal synergistic activation and their interactions. Given the role of brainstem descending pathways in body support and locomotion and post-stroke spasticity, a new perspective of understanding post-stroke hemiplegic gait is proposed. Its clinical implications for management of hemiplegic gait are discussed. Two cases are presented as clinical application examples.https://www.frontiersin.org/article/10.3389/fphys.2018.01021/fullgaitstrokehemiparesisspasticitybotulinum toxinmotor recovery |
| spellingShingle | Sheng Li Sheng Li Gerard E. Francisco Gerard E. Francisco Ping Zhou Ping Zhou Ping Zhou Post-stroke Hemiplegic Gait: New Perspective and Insights Frontiers in Physiology gait stroke hemiparesis spasticity botulinum toxin motor recovery |
| title | Post-stroke Hemiplegic Gait: New Perspective and Insights |
| title_full | Post-stroke Hemiplegic Gait: New Perspective and Insights |
| title_fullStr | Post-stroke Hemiplegic Gait: New Perspective and Insights |
| title_full_unstemmed | Post-stroke Hemiplegic Gait: New Perspective and Insights |
| title_short | Post-stroke Hemiplegic Gait: New Perspective and Insights |
| title_sort | post stroke hemiplegic gait new perspective and insights |
| topic | gait stroke hemiparesis spasticity botulinum toxin motor recovery |
| url | https://www.frontiersin.org/article/10.3389/fphys.2018.01021/full |
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