Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation

Dobkin, Bruce H.; Firestine, Ann; West, Michele; Saremi, Kaveh; Woods, Roger P.

doi:10.1016/j.neuroimage.2004.06.008

Cited by 273 publications

(280 citation statements)

References 83 publications

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“…70 The focus on ankle dorsiflexion arose from evidence that corticospinal drive to the ankle dorsiflexors is impaired in persons with SCI, 118 and control of ankle dorsiflexion represents a physiologic assay of locomotor control. 119 In comparison with a training intervention targeting reduction of reflex amplitude in the ankle plantar flexors, training to increase volitional control of dorsiflexors was associated with meaningful effects in a greater number of outcome measures including walking speed and step height. 70 Several locomotor training studies support the concept that targeting supraspinal control is a valuable approach for persons with SCI.…”

Section: Targeting Supraspinal Structuresmentioning

confidence: 98%

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Field-Fote

Yang

Basso

et al. 2017

Journal of Neurotrauma

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Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.

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Section: Targeting Supraspinal Structuresmentioning

confidence: 98%

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Field-Fote

Yang

Basso

et al. 2017

Journal of Neurotrauma

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“…At present, the opportunity to achieve maximal improvement is probably constrained by a lack of adequate data to define the optimal intensity (performance time, pace, and duration) of training strategies for specific disabilities. Functional neuroimaging studies may, in the future, help to guide decisions about the type and duration of treatment by providing insight into the maximal cortical reorganization that can be achieved with a particular therapy over time 47,48 ; however, this possibility requires much more research.…”

Section: Areas Of Uncertaintymentioning

confidence: 99%

Rehabilitation after Stroke

2005

Self Cite

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A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities? THE CLINICAL PROBLEMApproximately 400 persons per 100,000 population over the age of 45 years have a first stroke each year in the United States, Europe, and Australia. Stroke is the most frequent cause of adult-onset disability among people in the United States, and the cost of related care is among the fastest-growing expenses for Medicare. 1 The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without full physical assistance. 2 Six months after stroke, about 65 percent of patients cannot incorporate the affected hand into their usual activities. Poor upper-extremity outcomes are probable after a hemispheric infarction when the leg cannot move by two weeks and the hand has no movement or only slight finger flexion with no opening by four weeks, consistent with considerable damage to the corticospinal tract. 3 Patients who survive a stroke almost always have less physical disability by the end of the first three months. Functional scales, such as the Barthel Index and the Functional Independence Measure (which measure the physical assistance or supervision needed for self-care, including using the toilet, dressing, bathing, eating, and mobility), tend to show a plateau of gains by three to four months after stroke, partly owing to insensitivity of the scale to further improvements. Patients who no longer require assistance at that point may still be unable to use the affected hand, walk at speeds and distances that permit activities outside the home, or live alone. Only 25 percent of patients return to the level of everyday participation and physical functioning of community-matched persons who have not had a

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“…An impaired ankle dorsiflexion was shown to be a particular problem in stroke patients 14,30,34,35 and a delayed initiation of dorsiflexion in the swing phase is a predictor of falls in elderly people 36 . With a view to rehabilitation, ankle dorsiflexion has been proposed as a potential marker for gains in motor control of the lower extremity and as a substitute for multi joint walking movements of the affected leg in patients with stroke and SCI 14 .…”

Section: Relationship Of Paresis and Dexterity To Functionmentioning

confidence: 99%

“…As locomotion is a key function of the lower limbs, the focus of such an evaluation should be on functions that are relevant to gait. Ankle dorsiflexion was shown to be a critical component of the gait cycle in stroke and iSCI patients and was proposed as a potential marker for gains in motor control of the lower limb during rehabilitation 14 .…”

Section: Introductionmentioning

confidence: 99%

Foot control in incomplete SCI: distinction between paresis and dexterity

Wirth

Hedel

Curt

2008

Neurological Research

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Objective: To complement the clinical assessment of motor impairment after incomplete spinal cord injury (iSCI) by introducing a test that reliably distinguishes between muscle weakness (paresis) and impairment of dexterity in a simple foot motor task. Methods: Auditory-paced ankle dorsi-and plantarflexion, in a supine position, was studied in 30 controls (to establish control values and to test reliability) and in 16 iSCI patients (test validation). The subjects were instructed to initiate dorsi-and plantarflexion as accurately in timing and with the largest range of motion (ROM) possible. For each frequency, accuracy of timing, ROM, peak velocity of dorsi-and plantarflexion and a time quotient for changing from dorsi-to plantarflexion and vice versa were determined. In iSCI subjects, these parameters were related to clinical measures of paresis, spasticity and proprioception. Results: The test parameters showed good to very good reliability. The iSCI subjects were able to follow the target frequency with high accuracy, while ROM and peak velocity for dorsi-and plantarflexion were significantly reduced. Furthermore, there was a strong correlation between ROM/peak velocities and motor scores within the iSCI patients. Discussion: Repetitive foot dorsi-and plantarflexion enables a distinction to be made between muscle weakness and reduced dexterity as the underlying cause of affected foot control. This distinction between and quantification of these two movement components complements the existing clinical examination, and in follow-up works, the recovery of these components may provide further insight into the mechanisms underlying motor function improvement after iSCI. [Neurol Res 2008; 30: 52-60]

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Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation

Cited by 273 publications

References 83 publications

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Rehabilitation after Stroke

Foot control in incomplete SCI: distinction between paresis and dexterity

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