Abstract
Background: Many aspects of post-stroke gait-rehabilitation are based on low-level evidence or expert opinion. Neuroscientific principles are often not considered when evaluating the impact of interventions. The use of walking-aids including canes and rollators, although widely used for long periods, has primarily been investigated to assess the immediate kinetic, kinematic or physiological effects. The long-term impact on neural structures und functions remains unclear.
Methods: A literature review of the function of and factors affecting plasticity of spinal interneuronal-networks and central-pattern-generators (CPG) in healthy and post-stroke patients. The relevance of these mechanisms for gait recovery and the potential impact of walking-aids is discussed.
Results: Afferent-input to spinal-networks influences motor-output and spinal and cortical plasticity. Disrupted input may adversely affect post-stroke plasticity and functional recovery. Joint and muscle unloading and decoupling from four-limb CPG control may be particularly relevant.
Conclusions: Canes and rollators disrupt afferent-input and may negatively affect the recovery of gait. (C) 2016 Elsevier Ltd. All rights reserved.
Original language | English |
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Pages (from-to) | 422-434 |
Number of pages | 13 |
Journal | Journal of Bodywork and Movement Therapies |
Volume | 21 |
Issue number | 2 |
DOIs | |
Publication status | Published - Apr 2017 |
Keywords
- Cerebrovascular stroke
- Walking
- Assistive devices
- Central pattern generators
- Neuronal plasticity
- CORD-INJURY
- INTERLIMB COORDINATION
- LOCOMOTOR CIRCUITS
- SENSORY FEEDBACK
- MUSCLE-ACTIVITY
- LOAD RECEPTORS
- MOTOR CORTEX
- HUMANS
- REHABILITATION
- REFLEX