Experimental Brain Research

, Volume 186, Issue 2, pp 325–333 | Cite as

Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract

  • H. Dawes
  • C. Enzinger
  • H. Johansen-Berg
  • M. Bogdanovic
  • C. Guy
  • J. Collett
  • H. Izadi
  • C. Stagg
  • D. Wade
  • P. M. Matthews
Research Article


We investigated the association between the degree of lesion overlap with the corticospinal tract and walking performance before and after 4-weeks of partial body weight support (PBWS) treadmill training in 18 individuals (ten male, eight female) with a mean age 59 ± 13 years (mean ± SD), range 32–74 years, who were ambulant and 6 months from a subcortical ischaemic stroke. Lesion volumes were manually defined on high resolution T1-weighted 3T-MRI scans and a probabilistic map of the corticospinal tract created using diffusion tensor imaging data collected previously in healthy subjects. The percentage overlap between the lesion and the corticospinal tract was calculated for each patient. Walking performance was determined by measures of 10 m speed, spatiotemporal parameters, percentage recovery of centre of mass (CoM), walking symmetry and 2-min endurance walk prior to and following 4 weeks of treadmill training with PBWS that emphasised normal fast walking. Lesion overlap measures weakly correlated with walking performance measures. Spatiotemporal and performance measures changed in response to training, but spatial symmetry and mechanical energy recovery did not. Walking speed at entry to the study predicted change in response to training of 10 m walk time and swing time asymmetry. Age and lesion overlap did not add to prediction of outcome models. The extent of lesion overlap with the corticospinal tract was not strongly associated with either walking performance or response to gait retraining, despite the correlation of these parameters with upper limb recovery.


Stroke Speed Chronic Lesion Rehabilitation Walking 


  1. Ada L, Vattanasilp W, O’Dwyer NJ, Crosbie J (1998) Does spasticity contribute to walking dysfunction after stroke? J Neurol Neurosurg Psychiatry 64:628–635PubMedCrossRefGoogle Scholar
  2. Ahn YH, Ahn SH, Kim H, Hong JH, Jang SH (2006) Can stroke patients walk after complete lateral corticospinal tract injury of the affected hemisphere? Neuroreport 17(10):987–990PubMedCrossRefGoogle Scholar
  3. Baird AE, Dambrosia J, Janket S-J, Eichbaum Q, Chaves C, Silver B, Barber PA, Parsons M, Darby D, Davis S, Caplan LR, Edelman RE, Warach S (2001) A three-item scale for the early prediction of stroke recovery. Lancet 357:2095–2099PubMedCrossRefGoogle Scholar
  4. Behrens TE, Johansen-Berg H, Woolrich MW, Smith SM, Wheeler-Kingshott CA, Boulby PA, Barker GJ, Sillery EL, Sheehan K, Ciccarelli O, Thompson AJ, Brady JM, Matthews PM (2003) Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging. Nat Neurosci 6(7):750–757PubMedCrossRefGoogle Scholar
  5. Candelise L, Gattinoni M, Bersano A, Micieli G, Sterzi R, Morabito A (2007) Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369:299–305PubMedCrossRefGoogle Scholar
  6. Capaday C (2002) The special nature of human walking and its neural control. Trends Neurosci 25(7):370–376PubMedCrossRefGoogle Scholar
  7. Capaday C (2004) The integrated nature of motor cortical function. Neuroscientist 10(3):207–220PubMedCrossRefGoogle Scholar
  8. Carroll TJ, Baldwin ERL, Collins DF, Zehr EP (2006) Corticospinal excitability is lower during rhythmic arm movement than during tonic contraction. J Neurophysiol 95(2):914–921PubMedCrossRefGoogle Scholar
  9. Ciccarelli O, Wheeler-Kingshott CA, McLean MA, Cercignani M, Wimpey K, Miller DH, Thompson AJ (2007) Spinal cord spectroscopy and diffusion-based tractography to assess acute disability in multiple sclerosis. Brain 130(8):2220–2231PubMedCrossRefGoogle Scholar
  10. CGA m-l 2006 Statistics what people have said, FAQ K.C, clinical gait analysis., accessed on 2007
  11. Collen FM, Robb GF, Bradshaw CM (1991) The Rivermead mobility index: a further development of the Rivermead motor assessment. Int Disabil Stud 13:50–54PubMedGoogle Scholar
  12. Collin C, Wade DT, Davies S, Horne V (1988) The Barthel index: a reliability study. Int Disabil Stud 10:61–63PubMedGoogle Scholar
  13. Dawes H, Smith C, Collett J, Wade D, Howells K, Ramsbottom R, Izadi H, Sackley C (2005) A pilot study to investigate explosive leg extensor power and walking performance after stroke. J Sports Sci Med (4):556–562Google Scholar
  14. Den Otter AR, Geurts ACH, Mulder T, Duysens J (2006) Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis. Clin Neurophysiol 117(1):4–15CrossRefGoogle Scholar
  15. Dimitrijevic M, Gerasimenko Y, Pinter M (1998) Evidence for a spinal central pattern generator in humans. Ann N T Acad Sci 860:360–376CrossRefGoogle Scholar
  16. Dobkin BH, Firestine A, West M, Saremi K, Woods R (2004) Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation. Neuroimage 23(1):370–381PubMedCrossRefGoogle Scholar
  17. Forrester LW, Hanley DF, Macko RF (2006) Effects of treadmill exercise on transcranial magnetic stimulation-induced excitability to quadriceps after stroke. Arch Phys Med Rehabil 87(2):229–234PubMedCrossRefGoogle Scholar
  18. Friedman PJ (1990) Gait recovery after hemiplegic stroke. Int Disabil Stud 12(3):119–122PubMedGoogle Scholar
  19. Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N (2005) Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res 164:541–548PubMedCrossRefGoogle Scholar
  20. Heiervang E, Behrens TE, Mackay CE, Robson MD, Johansen-Berg H (2006) Between session reproducibility and between subject variability of diffusion MR and tractography measures. Neuroimage 33(3):867–877PubMedCrossRefGoogle Scholar
  21. Hesse S, Reiter F, Jahnke M, Dawson M, Sarkodie-Gyan T, Mauritz KH (1997) Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil 78(7):719–724PubMedCrossRefGoogle Scholar
  22. Hultborn HN (2007) Spinal control of locomotion––from cat to man. Acta Physiol (Oxf) 189:111–121Google Scholar
  23. Jang SH, You SH, Kwon YH, Hallett M, Lee MY, Ahn SH (2005) Cortical reorganization associated lower extremity motor recovery as evidenced by functional MRI and diffusion tensor tractography in a stroke patient. Restor Neurol Neurosci 23(5–6):325–329PubMedGoogle Scholar
  24. Jang SH, Ahn SH, Ha JS, Lee SJ, Lee J, Ahn YH (2006) Peri-infarct reorganization in a patient with corona radiata infarct: a combined study of functional MRI and diffusion tensor image tractography. Restor Neurol Neurosci 24(2):65–68PubMedGoogle Scholar
  25. Jenkinson M, Bannister PR, Brady JM, Smith SM (2002) Improved optimisation for the robust and accurate linear registration and motion correction of brain images. Neuroimage 17(2):825–841PubMedCrossRefGoogle Scholar
  26. Johansen-Berg H, Dawes H, Guy C, Smith SM, Wade DT, Matthews PM (2002a) Correlation between motor improvements and altered fMRI activity after rehabilitative therapy. Brain 125:2731–2742PubMedCrossRefGoogle Scholar
  27. Johansen-Berg H, Rushworth MF, Bogdanovic MD, Kischka U, Wimalaratna S, Matthews PM (2002b) The role of ipsilateral premotor cortex in hand movement after stroke. Proc Natl Acad Sci USA 99(22):14518–14523PubMedCrossRefGoogle Scholar
  28. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Recovery of walking function in stroke patients: the Copenhagen stroke study. Arch Phys Med Rehabil 76(1):27–32PubMedCrossRefGoogle Scholar
  29. Lemon RN, Griffiths J (2005) Comparing the function of the corticospinal system in different species: organizational differences for motor specialization? Muscle Nerve 32(3):261–279PubMedCrossRefGoogle Scholar
  30. Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP (2005) Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke––a randomized, controlled trial. Stroke 36(10):2206–2211PubMedCrossRefGoogle Scholar
  31. Menz HB, Latt MD, Tiedemann A, Mun San Kwan M, Lord SR (2004) Reliability of the GAITRite walkiway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture 20:20–25PubMedCrossRefGoogle Scholar
  32. Nakamura S, Akiguchi I, Kameyama M, Mizuno N (1985) Age-related changes of pyramidal cell basal dendrites in layers III and V of human motor cortex: a quantitative Golgi study. Acta Neuropathol 65(3–4):281–284PubMedCrossRefGoogle Scholar
  33. Nielsen JB (2002) Motoneuronal drive during human walking. Brain Res Rev 40(1–3):192–201CrossRefGoogle Scholar
  34. Pineiro R, Pendlebury ST, Smith S, Flitney D, Blamire AM, Styles P, Matthews PM (2000) Relating MRI changes to motor deficit after ischemic stroke by segmentation of functional motor pathways. Stroke 31(3):672–679PubMedGoogle Scholar
  35. Pohl M, Mehrholz J, Ritschel C, Ruckriem S (2002) Speed-dependent treadmill training in ambulatory hemiparetic stroke patients––a randomized controlled trial. Stroke 33(2):553–558PubMedCrossRefGoogle Scholar
  36. Regnaux JP, David D, Daniel O, Ben Smail D, Combeaud M, Bussel B (2005) Evidence for cognitive processes involved in the control of steady state of walking in healthy subjects and after cerebral damage. Neurorehabil Neural Repair 19(2):125–132PubMedCrossRefGoogle Scholar
  37. Reisman DS, Block HJ, Bastian AJ (2005) Interlimb coordination during locomotion: what can be adapted and stored? J Neurophysiol 94:2403–2415PubMedCrossRefGoogle Scholar
  38. Saini M, Kerrigan DC, Thirunarayan MA, Duff-Raffaele M (1998) The vertical displacement of the center of mass during walking: a comparison of four measurement methods. J Biomech Eng Trans ASME 120(1):133–139CrossRefGoogle Scholar
  39. Scheibel ME, Lindsay RD, Tomiyasu U, Scheibel AB (1975) Progressive dendritic changes in aging human cortex. Exp Neurol 47(3):392–403PubMedCrossRefGoogle Scholar
  40. Schiemanck SK, Kwakkel G, Post MWM, Kappelle LJ, Prevo AJH (2006) Predicting long-term independency in activities of daily living after middle cerebral artery stroke––Does information from MRI have added predictive value compared with clinical information? Stroke 37(4):1050–1054PubMedCrossRefGoogle Scholar
  41. Shapkova E (2004) Spinal locomotor capability revealed by electrical stimulation of the lumbar enlargement in paraplegic patients, vol 3. Human Kinetics PublishersGoogle Scholar
  42. Shapkova E, Schomburg E (2001) Two types of motor modulation underlying human stepping evoked by spinal cord electrical stimulation (SCES). Acta Physiol Pharmacol Bulg 26:155–157PubMedGoogle Scholar
  43. Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH (2004) Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke 35:134–139PubMedCrossRefGoogle Scholar
  44. Sullivan KJ, Knowlton BJ, Dobkin BH (2002) Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil 83(5):683–691PubMedCrossRefGoogle Scholar
  45. Stinear CM, Smale PR, Coxon JP, Fleming MK, Byblow WD (2007) Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain 130:170–180PubMedCrossRefGoogle Scholar
  46. Thirunarayan MA, Kerrigan DC, Rabuffetti M, Della Croce U, Saini M (1996) Comparison of 3 methods for estimating vertical displacement of center of mass during level walking in patients. Gait Posture 4:306–314CrossRefGoogle Scholar
  47. Tombari D, Loubinoux I, Pariente J, Gerdelat A, Albucher JF, Tardy J, Cassol E, Chollet F (2004) A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients. Neuroimage 23(3):827–839PubMedCrossRefGoogle Scholar
  48. Van de Crommert H, Mulder T, Duysens J (1998) Neural control of locomotion: sensory control of the central patern generator and its relation to treadmill training. Gait Posture 7:251–263PubMedCrossRefGoogle Scholar
  49. Wade DT (1992) Measurement in neurological rehabilitation. Oxford University Press, Oxford, pp 170–171Google Scholar
  50. Wang WJ, Crompton RH, Gunther M (2003) Energy transformation during erect and ‘bent-hip, bent-knee’ walking by humans with implications for the evolution of bipedalism. J Hum Evol 44:563–579PubMedCrossRefGoogle Scholar
  51. Woollacott M, Shumway-Cook A (2002) Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 16:1–14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • H. Dawes
    • 1
    • 3
  • C. Enzinger
    • 2
  • H. Johansen-Berg
    • 3
  • M. Bogdanovic
    • 3
  • C. Guy
    • 5
  • J. Collett
    • 4
  • H. Izadi
    • 6
  • C. Stagg
    • 3
  • D. Wade
    • 5
  • P. M. Matthews
    • 7
    • 8
  1. 1.Movement Science Group, School of Life SciencesOxford Brookes UniversityOxfordUK
  2. 2.Department of Neurology and Section of NeuroradiologyMedical University GrazGrazAustria
  3. 3.Department of Clinical NeurologyUniversity of OxfordOxfordUK
  4. 4.School of Life SciencesOxford Brookes UniversityOxfordUK
  5. 5.Oxford Centre for EnablementOxfordUK
  6. 6.Department of Mathematical Sciences, School of TechnologyOxford Brookes UniversityOxfordUK
  7. 7.FMRIBUniversity of OxfordOxfordUK
  8. 8.GlaxoSmithKlineImperial College LondonLondonUK

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