Physiological evaluation of gait disturbances post stroke

A large proportion of stroke survivors have to deal with problems in mobility. Proper evaluations must be undertaken to understand the sensorimotor impairments underlying locomotor disorders post stroke, so that evidence-based interventions can be developed. The current electrophysiological, biomechanical, and imagery evaluations that provide insight into locomotor dysfunction post stroke, as well as their advantages and limitations, are reviewed in this paper. In particular, electrophysiological evaluations focus on the contrast of electromyographic patterns and integrity of spinal reflex pathways during perturbed and unperturbed locomotion between persons with stroke and healthy individuals. At a behavioral level, biomechanical evaluations that include temporal distance factors, kinematic and kinetic analyses, as well as the mechanical energy and metabolic cost, are useful when combined with electrophysiological measures for the interpretation of gait disturbances that are related to the control of the central nervous system or secondary to biomechanical constraints. Finally, current methods in imaging and transcranial magnetic stimulation can provide further insight into cortical control of locomotion and the integrity of the corticospinal pathways.

[1]  J. Nielsen,et al.  Reflex excitation of muscles during human walking. , 2002, Advances in experimental medicine and biology.

[2]  Ching-yi Wu,et al.  Gait Performance with Compensatory Adaptations in Stroke Patients with Different Degrees of Motor Recovery , 2003, American journal of physical medicine & rehabilitation.

[3]  P. Rabischong,et al.  Plantar dynamics of hemiplegic gait: a methodological approach , 1996 .

[4]  T Sinkjaer,et al.  Mechanical and electromyographic analysis of reciprocal inhibition at the human ankle joint. , 1995, Journal of neurophysiology.

[5]  T. Sinkjær,et al.  H‐reflex modulation during gait in multiple sclerosis patients with spasticity , 1995, Acta neurologica Scandinavica.

[6]  A L Hof,et al.  Detection of non-standard EMG profiles in walking. , 2005, Gait & posture.

[7]  Walking cycle after stroke. , 1988, The Tohoku journal of experimental medicine.

[8]  C. Richards,et al.  Mechanisms of disturbed motor control in ankle weakness during gait after stroke. , 2002, Gait & posture.

[9]  Thomas Sinkjær,et al.  Muscle, reflex and central components in the control of the ankle joint in healthy and spastic man. , 1997 .

[10]  J. Duysens,et al.  Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis , 2006, Clinical Neurophysiology.

[11]  J. Nielsen,et al.  Modulation of heteronymous reflexes from ankle dorsiflexors to hamstring muscles during human walking , 2002, Experimental Brain Research.

[12]  P. Goldie,et al.  Deficit and change in gait velocity during rehabilitation after stroke. , 1996, Archives of physical medicine and rehabilitation.

[13]  J. Duysens,et al.  In humans Ib facilitation depends on locomotion while suppression of Ib inhibition requires loading , 2006, Brain Research.

[14]  J. Nielsen,et al.  The effect of transcranial magnetic stimulation on the soleus H reflex during human walking , 1998, The Journal of physiology.

[15]  R. Tallis,et al.  Dual-task effects of talking while walking on velocity and balance following a stroke. , 2001, Age and ageing.

[16]  S. Meunier,et al.  Further evidence for non-monoynaptic group I excitation of motoneurones in the human lower limb , 1997, Experimental Brain Research.

[17]  J. Rothwell,et al.  Techniques and mechanisms of action of transcranial stimulation of the human motor cortex , 1997, Journal of Neuroscience Methods.

[18]  R B Stein,et al.  Reflexes from the superficial peroneal nerve during walking in stroke subjects. , 1998, Journal of neurophysiology.

[19]  Murray Mp,et al.  Kinematic and EMG patterns during slow, free, and fast walking , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  V. L. Nickel,et al.  Gait parameters following stroke: a practical assessment. , 1995, Journal of rehabilitation research and development.

[21]  M. Bonnard,et al.  On-line flexibility of the cognitive tuning of corticospinal excitability: A TMS study in human gait , 2006, Brain Research.

[22]  M P Murray,et al.  COMPARISON OF FREE AND FAST SPEED WALKING PATTERNS OF NORMAL MEN , 1966, American journal of physical medicine.

[23]  T. Kuan,et al.  Hemiplegic gait of stroke patients: the effect of using a cane. , 1999, Archives of physical medicine and rehabilitation.

[24]  Energy expenditure of hemiplegic subjects during walking. , 1963, Archives of physical medicine and rehabilitation.

[25]  C. Detrembleur,et al.  Energy cost, mechanical work, and efficiency of hemiparetic walking. , 2003, Gait & posture.

[26]  J. Nielsen,et al.  Transcranial magnetic stimulation and stretch reflexes in the tibialis anterior muscle during human walking , 2001, The Journal of physiology.

[27]  Mary Rodgers,et al.  Bilateral foot center of pressure measures predict hemiparetic gait velocity. , 2006, Gait & posture.

[28]  R. Stein,et al.  H-Reflex Modulation During Walking in Spastic Paretic Subjects , 1991, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[29]  K. Kubota,et al.  Cortical Mapping of Gait in Humans: A Near-Infrared Spectroscopic Topography Study , 2001, NeuroImage.

[30]  W Z Rymer,et al.  Joint dependent passive stiffness in paretic and contralateral limbs of spastic patients with hemiparetic stroke. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[31]  P Berlit,et al.  Dynamic plantar pressure distribution measurements in hemiparetic patients. , 1997, Clinical biomechanics.

[32]  C. Capaday,et al.  Difference in the amplitude of the human soleus H reflex during walking and running. , 1987, The Journal of physiology.

[33]  A. Patla,et al.  Effect of stroke on step characteristics of obstacle crossing. , 2001, Archives of physical medicine and rehabilitation.

[34]  Jaynie F. Yang,et al.  Short latency, non-reciprocal group I inhibition is reduced during the stance phase of walking in humans , 1996, Brain Research.

[35]  R W Bohannon,et al.  Gait performance of hemiparetic stroke patients: selected variables. , 1987, Archives of physical medicine and rehabilitation.

[36]  H Johansen-Berg,et al.  Towards an understanding of gait control: brain activation during the anticipation, preparation and execution of foot movements , 2004, NeuroImage.

[37]  A. Curt,et al.  Corticospinal input in human gait: modulation of magnetically evoked motor responses , 1997, Experimental Brain Research.

[38]  S. Olney,et al.  Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors. , 2001, Journal of rehabilitation medicine.

[39]  M. Hallett,et al.  Transcranial magnetic stimulation techniques in clinical investigation , 2002, Neurology.

[40]  J. Nielsen,et al.  Major role for sensory feedback in soleus EMG activity in the stance phase of walking in man , 2000, The Journal of physiology.

[41]  M. MacKay-Lyons,et al.  Exercise capacity early after stroke. , 2002, Archives of physical medicine and rehabilitation.

[42]  Daniel P. Ferris,et al.  Soleus H‐reflex gain in humans walking and running under simulated reduced gravity , 2001, The Journal of physiology.

[43]  I. bonan,et al.  A clinical guide to assess the role of lower limb extensor overactivity in hemiplegic gait disorders. , 1999, Stroke.

[44]  S. Olney,et al.  Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. , 1994, Physical therapy.

[45]  Jens Bo Nielsen,et al.  Motoneuronal drive during human walking , 2002, Brain Research Reviews.

[46]  K Potempa,et al.  Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. , 1995, Stroke.

[47]  C. Richards,et al.  Locomotor-specific measure of spasticity of plantarflexor muscles after stroke. , 2001, Archives of physical medicine and rehabilitation.

[48]  P. Marque,et al.  Facilitation of transmission in heteronymous group II pathways in spastic hemiplegic patients , 2001, Journal of neurology, neurosurgery, and psychiatry.

[49]  R. Stein,et al.  Multicenter evaluation of electrical stimulation systems for walking. , 1999, Archives of physical medicine and rehabilitation.

[50]  S. Nadeau,et al.  Muscular utilization of the plantarflexors, hip flexors and extensors in persons with hemiparesis walking at self-selected and maximal speeds. , 2007, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[51]  J. Duysens,et al.  Cutaneous reflexes from the foot during gait in hereditary spastic paraparesis , 2004, Clinical Neurophysiology.

[52]  M. Bonnard,et al.  Cognitive tuning of corticospinal excitability during human gait: adaptation to the phase , 2004 .

[53]  C. Richards,et al.  Brain activations during motor imagery of locomotor‐related tasks: A PET study , 2003, Human brain mapping.

[54]  Lars Arendt-Nielsen,et al.  Modulation of lower limb withdrawal reflexes during gait: a topographical study. , 2004, Journal of neurophysiology.

[55]  Francine Malouin,et al.  The relationship of gait speed to clinical measures of function and muscle activations during recovery post-stroke☆ , 1993 .

[56]  G. Hirschberg,et al.  ANALYSIS OF THE HEMIPLEGIC GAIT , 1958, Annals of the New York Academy of Sciences.

[57]  A. Lundberg Multisensory control of spinal reflex pathways. , 1979, Progress in brain research.

[58]  J. Eng,et al.  Magnitude and pattern of 3D kinematic and kinetic gait profiles in persons with stroke: relationship to walking speed. , 2004, Gait & posture.

[59]  Paul Van Hecke,et al.  Brain Areas Involved in Interlimb Coordination: A Distributed Network , 2001, NeuroImage.

[60]  J. Duysens,et al.  Load-regulating mechanisms in gait and posture: comparative aspects. , 2000, Physiological reviews.

[61]  Charles Capaday,et al.  Neurophysiological methods for studies of the motor system in freely moving human subjects , 1997, Journal of Neuroscience Methods.

[62]  R. Brand,et al.  The biomechanics and motor control of human gait: Normal, elderly, and pathological , 1992 .

[63]  Thomas Sinkjær,et al.  Impaired stretch reflex and joint torque modulation during spastic gait in multiple sclerosis patients , 1996, Journal of Neurology.

[64]  C. Richards,et al.  Walking speed over 10 metres overestimates locomotor capacity after stroke , 2001, Clinical rehabilitation.

[65]  H Barbeau,et al.  Effects of conditioning cutaneomuscular stimulation on the soleus H-reflex in normal and spastic paretic subjects during walking and standing. , 1994, Journal of neurophysiology.

[66]  C. Richards,et al.  Contribution of passive stiffness to ankle plantarflexor moment during gait after stroke. , 2000, Archives of physical medicine and rehabilitation.

[67]  Jack Crosbie,et al.  Does spasticity contribute to walking dysfunction after stroke? , 1998, Journal of neurology, neurosurgery, and psychiatry.

[68]  M. Faist,et al.  Amplitude modulation of the quadriceps H-reflex in the human during the early stance phase of gait , 2004, Experimental Brain Research.

[69]  D. Ma,et al.  Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. , 1987 .

[70]  Ichiro Miyai,et al.  Premotor cortex is involved in restoration of gait in stroke , 2002, Annals of neurology.

[71]  K. Pearson,et al.  Entrainment of the locomotor rhythm by group Ib afferents from ankle extensor muscles in spinal cats , 2004, Experimental Brain Research.

[72]  F. Malouin,et al.  Non-reflex mediated changes in plantarflexor muscles early after stroke. , 1997, Scandinavian journal of rehabilitation medicine.

[73]  V. Dietz,et al.  Amplitude modulation of the human quadriceps tendon jerk reflex during gait , 2004, Experimental Brain Research.

[74]  P Haggard,et al.  Interference between gait and cognitive tasks in a rehabilitating neurological population , 2000, Journal of neurology, neurosurgery, and psychiatry.

[75]  I. Tarkka,et al.  Footprint peak time and functional ambulation profile reflect the potential for hemiparetic gait recovery , 2005, Brain injury.

[76]  B. Bussel,et al.  Evidence for Cognitive Processes Involved in the Control of Steady State of Walking in Healthy Subjects and after Cerebral Damage , 2005, Neurorehabilitation and neural repair.

[77]  V. Dietz Proprioception and locomotor disorders , 2002, Nature Reviews Neuroscience.

[78]  A. Patla,et al.  Control of lead and trail limbs during obstacle crossing following stroke. , 2005, Physical therapy.

[79]  A. Thilmann,et al.  Biomechanical changes at the ankle joint after stroke. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[80]  M. Voigt,et al.  The amplitude modulation of the Quadriceps H-reflex in relation to the knee joint action during walking , 2006, Experimental Brain Research.

[81]  J. Nielsen,et al.  Afferent feedback in the control of human gait. , 2002, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[82]  T. Sinkjaer,et al.  The stretch reflex and H-reflex of the human soleus muscle during walking. , 1999, Motor control.

[83]  J. Duysens,et al.  Step characteristics during obstacle avoidance in hemiplegic stroke , 2005, Experimental Brain Research.

[84]  H. Fukuyama,et al.  Brain functional activity during gait in normal subjects: a SPECT study , 1997, Neuroscience Letters.

[85]  P. Marque,et al.  Modulation of the transmission in group II heteronymous pathways by tizanidine in spastic hemiplegic patients. , 2004, Journal of neurology, neurosurgery, and psychiatry.

[86]  Gerald V. Smith,et al.  Treadmill training improves fitness reserve in chronic stroke patients. , 2001, Archives of physical medicine and rehabilitation.

[87]  E. Zehr,et al.  Cutaneous reflexes during human gait: electromyographic and kinematic responses to electrical stimulation. , 1997, Journal of neurophysiology.

[88]  Christian Ethier,et al.  On the soleus H-reflex modulation pattern during walking , 2003, Experimental Brain Research.

[89]  J. Nielsen,et al.  Modulation of non‐monosynaptic excitation from ankle dorsiflexor afferents to quadriceps motoneurones during human walking , 2002, The Journal of physiology.

[90]  M. Faist,et al.  Modulation, probably presynaptic in origin, of monosynaptic Ia excitation during human gait , 1996, Experimental Brain Research.

[91]  Thomas Sinkjær,et al.  An actuator system for investigating electrophysiological and biomechanical features around the human ankle joint during gait , 1995 .

[92]  P. Zamparo,et al.  The energy cost of level walking in patients with hemiplegia , 1995, Scandinavian journal of medicine & science in sports.

[93]  E B Simonsen,et al.  Excitability of the soleus H reflex during graded walking in humans. , 1995, Acta physiologica Scandinavica.

[94]  V. Marchand-Pauvert,et al.  The pattern of excitation of human lower limb motoneurones by probable group II muscle afferents , 1999, The Journal of physiology.

[95]  Felix E Zajac,et al.  Gait deviations associated with post-stroke hemiparesis: improvement during treadmill walking using weight support, speed, support stiffness, and handrail hold. , 2005, Gait & posture.

[96]  J. Nielsen,et al.  Sensitivity of H-reflexes and stretch reflexes to presynaptic inhibition in humans. , 1998, Journal of neurophysiology.

[97]  Corcoran Pj,et al.  Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. , 1970 .

[98]  E. Zehr,et al.  What functions do reflexes serve during human locomotion? , 1999, Progress in Neurobiology.

[99]  J. Nielsen,et al.  Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury. , 2003, Brain : a journal of neurology.

[100]  Meg E Morris,et al.  Lateral pelvic displacement during gait: abnormalities after stroke and changes during the first month of rehabilitation. , 2003, Archives of physical medicine and rehabilitation.

[101]  C. Richards,et al.  Coactivation during gait as an adaptive behavior after stroke. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[102]  S. Hesse,et al.  Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. , 2001, Archives of physical medicine and rehabilitation.

[103]  J. Perry,et al.  Factors Affecting Balance and Ambulation Following Stroke , 1984, Clinical orthopaedics and related research.

[104]  T Sinkjaer,et al.  Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. , 1994, Brain : a journal of neurology.

[105]  C. Calautti,et al.  Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults: A Review , 2003, Stroke.

[106]  V. Dietz,et al.  Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[107]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[108]  M. Bonnard,et al.  Task‐induced modulation of motor evoked potentials in upper‐leg muscles during human gait: a TMS study , 2002, The European journal of neuroscience.

[109]  N. Ward,et al.  Plasticity and the functional reorganization of the human brain. , 2005, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[110]  S. Nadeau,et al.  Quantification of level of effort at the plantarflexors and hip extensors and flexor muscles in healthy subjects walking at different cadences. , 2005, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[111]  C. Capaday,et al.  Amplitude modulation of the soleus H-reflex in the human during walking and standing , 1986, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[112]  A. Curt,et al.  Voluntary control of human gait: conditioning of magnetically evoked motor responses in a precision stepping task , 1999, Experimental Brain Research.

[113]  J. Fung,et al.  Faster Is Better: Implications for Speed-Intensive Gait Training After Stroke , 2004, Stroke.

[114]  H. Hultborn,et al.  Transmission in a locomotor-related group Ib pathway from hindlimb extensor muscles in the cat , 2004, Experimental Brain Research.

[115]  F Felici,et al.  Cost of walking and locomotor impairment. , 1999, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[116]  F. Piccione,et al.  Clinical correlation between motor evoked potentials and gait recovery in poststroke patients. , 2005, Archives of physical medicine and rehabilitation.

[117]  David Burke,et al.  The Circuitry of the Human Spinal Cord: Its Role in Motor Control and Movement Disorders , 2005 .

[118]  Joyce Fung,et al.  Stroke affects the coordination and stabilization of head, thorax and pelvis during voluntary horizontal head motions performed in walking , 2005, Clinical Neurophysiology.

[119]  H. Barbeau,et al.  A dynamic EMG profile index to quantify muscular activation disorder in spastic paretic gait. , 1989, Electroencephalography and clinical neurophysiology.

[120]  R. Stein,et al.  Factors that determine the magnitude and time course of human H- reflexes in locomotion , 1991, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[121]  J. Lehmann,et al.  Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. , 1987, Archives of physical medicine and rehabilitation.

[122]  G. Hirschberg,et al.  Electromyographic recording of muscular activity in normal and spastic gaits. , 1952, Archives of physical medicine and rehabilitation.

[123]  J. F. Yang,et al.  Contribution of peripheral afferents to the activation of the soleus muscle during walking in humans , 2004, Experimental Brain Research.

[124]  P A Costigan,et al.  Mechanical energy of walking of stroke patients. , 1986, Archives of physical medicine and rehabilitation.

[125]  V. Dietz,et al.  Normal and impaired regulation of muscle stiffness in gait: A new hypothesis about muscle hypertonia , 1983, Experimental Neurology.

[126]  G Colombo,et al.  Cortical facilitation of cutaneous reflexes in leg muscles during human gait , 1998, Brain Research.

[127]  C. Gowland,et al.  Hemiplegic gait: analysis of temporal variables. , 1983, Archives of physical medicine and rehabilitation.

[128]  T. Sinkjaer,et al.  Soleus stretch reflex modulation during gait in humans. , 1996, Journal of neurophysiology.

[129]  N. Mrachacz-Kersting,et al.  Characterisation of the quadriceps stretch reflex during the transition from swing to stance phase of human walking , 2004, Experimental Brain Research.

[130]  E. Simonsen,et al.  Amplitude of the human soleus H reflex during walking and running , 1999, The Journal of physiology.

[131]  K. Pearson,et al.  Inhibition of flexor burst generation by loading ankle extensor muscles in walking cats , 1980, Brain Research.

[132]  Michael J Grey,et al.  Ankle extensor proprioceptors contribute to the enhancement of the soleus EMG during the stance phase of human walking. , 2004, Canadian journal of physiology and pharmacology.

[133]  J. F. Yang,et al.  Phase-dependent reflex reversal in human leg muscles during walking. , 1990, Journal of neurophysiology.

[134]  S. Olney,et al.  Work and power in gait of stroke patients. , 1991, Archives of physical medicine and rehabilitation.

[135]  T Limbird,et al.  Electromyographic gait assessment, Part 2: Preliminary assessment of hemiparetic synergy patterns. , 1987, Journal of rehabilitation research and development.

[136]  C. Capaday,et al.  Studies on the corticospinal control of human walking. I. Responses to focal transcranial magnetic stimulation of the motor cortex. , 1999, Journal of neurophysiology.

[137]  C Capaday,et al.  On the origin of the soleus H-reflex modulation pattern during human walking and its task-dependent differences. , 2000, Journal of neurophysiology.

[138]  P O Riley,et al.  Spastic Paretic Stiff-Legged Gait: Joint Kinetics , 2001, American journal of physical medicine & rehabilitation.

[139]  P. Marque,et al.  Evidence for excitation of the human lower limb motoneurones by group II muscle afferents , 1996, Experimental Brain Research.

[140]  R. Kearney,et al.  Identification of intrinsic and reflex ankle stiffness components in stroke patients , 2005, Experimental Brain Research.

[141]  M. Faist,et al.  A quantitative assessment of presynaptic inhibition of Ia afferents in spastics. Differences in hemiplegics and paraplegics. , 1994, Brain : a journal of neurology.

[142]  J. Nielsen,et al.  Suppression of EMG activity by transcranial magnetic stimulation in human subjects during walking , 2001, The Journal of physiology.

[143]  A E Patla,et al.  Obstacle crossing in subjects with stroke. , 1999, Archives of physical medicine and rehabilitation.

[144]  C. Richards,et al.  Potential role of mental practice using motor imagery in neurologic rehabilitation. , 2001, Archives of physical medicine and rehabilitation.

[145]  T. Sinkjær,et al.  A task dependent change in the medium latency component of the soleus stretch reflex , 2002, Experimental Brain Research.

[146]  J. Maarek,et al.  Mapping brain function in freely moving subjects , 2004, Neuroscience & Biobehavioral Reviews.

[147]  M. Faist,et al.  Impaired modulation of quadriceps tendon jerk reflex during spastic gait: differences between spinal and cerebral lesions. , 1999, Brain : a journal of neurology.

[148]  J. Hidler,et al.  Quantification of the dynamic properties of EMG patterns during gait. , 2005, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[149]  W. J. Beek,et al.  Hemiplegic gait: a kinematic analysis using walking speed as a basis. , 1992, Journal of biomechanics.

[150]  Andreas R. Luft,et al.  Brain activation of lower extremity movement in chronically impaired stroke survivors , 2005, NeuroImage.

[151]  J MacGregor The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. , 1981, Physiotherapy.

[152]  G. Moskowitz,et al.  Passive and active components of the internal moment developed about the ankle joint during human ambulation. , 1984, Journal of biomechanics.

[153]  E Knutsson,et al.  Different types of disturbed motor control in gait of hemiparetic patients. , 1979, Brain : a journal of neurology.

[154]  M. Bonnard,et al.  Direct Evidence for a Binding between Cognitive and Motor Functions in Humans: A TMS Study , 2003, Journal of Cognitive Neuroscience.

[155]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[156]  S. Nadeau,et al.  Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. , 1999, Clinical biomechanics.

[157]  M. Schieppati,et al.  Reflex contribution of spindle group Ia and II afferent input to leg muscle spasticity as revealed by tendon vibration in hemiparesis , 2005, Clinical Neurophysiology.

[158]  J. Duysens,et al.  Abeta fibers mediate cutaneous reflexes during human walking. , 2000, Journal of neurophysiology.

[159]  J. Duysens,et al.  Vibration-induced changes in EMG during human locomotion. , 2003, Journal of neurophysiology.

[160]  J Duysens,et al.  Abnormalities in the temporal patterning of lower extremity muscle activity in hemiparetic gait. , 2007, Gait & posture.

[161]  P. Delwaide,et al.  Short-latency autogenic inhibition (IB inhibition) in human spasticity. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[162]  F. Zajac,et al.  Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. , 2005, Gait & posture.

[163]  Willy Gsell,et al.  The use of cerebral blood flow as an index of neuronal activity in functional neuroimaging: experimental and pathophysiological considerations , 2000, Journal of Chemical Neuroanatomy.

[164]  Jaynie F. Yang,et al.  Reflex Behavior during Walking in Incomplete Spinal-Cord-Injured Subjects , 1994, Experimental Neurology.

[165]  Boniface Sj Plasticity after acute ischaemic stroke studied by transcranial magnetic stimulation. , 2001 .

[166]  Thomas Sinkjær,et al.  Group II muscle afferents probably contribute to the medium latency soleus stretch reflex during walking in humans , 2001, The Journal of physiology.

[167]  G Avanzini,et al.  Motor Development in children , 1994 .

[168]  G. Hirschberg,et al.  Gait analysis in hemiplegia. , 1951, Transactions of the American Neurological Association.