Experimental Brain Research

, Volume 209, Issue 1, pp 9–17 | Cite as

Non-invasive brain stimulation enhances fine motor control of the hemiparetic ankle: implications for rehabilitation

  • Sangeetha MadhavanEmail author
  • Kenneth A. WeberII
  • James W. Stinear
Research Article


We set out to answer two questions with this study: 1. Can stroke patients improve voluntary control of their paretic ankle by practising a visuo-motor ankle-tracking task? 2. Are practice effects enhanced with non-invasive brain stimulation? A carefully selected sample of chronic stroke patients able to perform the experimental task attended three data collection sessions. Facilitatory transcranial direct current stimulation (tDCS) was applied in a random order over the lower limb primary motor cortex of the lesioned hemisphere or the non-lesioned hemisphere or sham stimulation was delivered over the lesioned hemisphere. In each session, tDCS was applied as patients practiced tracking a sinusoidal waveform for 15 min using dorsiflexion–plantarflexion movements of their paretic ankle. The difference in tracking error prior to, and after, the 15 min of practice was calculated. A practice effect was revealed following sham stimulation, and this effect was enhanced with tDCS applied over the lesioned hemisphere. The practice effect observed following sham stimulation was eliminated by tDCS applied over the non-lesioned hemisphere. The study provides the first evidence that non-invasive brain stimulation applied to the lesioned motor cortex of moderate- to well-recovered stroke patients enhances voluntary control of the paretic ankle. The results provide a basis for examining whether this enhanced ankle control can be induced in patients with greater impairments and whether enhanced control of a single or multiple lower limb joints improves hemiparetic gait patterns.


Stroke Ankle tDCS TMS Motor practice 



The study was funded by NIH grants K01HD056216 (JWS), R21HD059287 (JWS), and the Olson Family. SM was supported by a grant from the Department of Education, NIDRR H133F090009. We are grateful to Heidi Roth PT, MSPT for patient recruitment and screening.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Sangeetha Madhavan
    • 1
    Email author
  • Kenneth A. WeberII
    • 2
  • James W. Stinear
    • 2
    • 3
  1. 1.Department of Physical TherapyUniversity of IllinoisChicagoUSA
  2. 2.Sensory Motor Performance ProgramRehabilitation Institute of ChicagoChicagoUSA
  3. 3.Department of Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoUSA

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