Despite advances in gait research in the last decade, restoration of community walking continues to be an unaccomplished goal for over four million persons with stroke. Recent human studies have highlighted the significant involvement of the motor cortex in walking, emphasizing the need to develop research paradigms that provide a better understanding of cortical mechanisms in order to develop more effective walking training protocols. Transcranial direct current stimulation (tDCS) is emerging as a promising tool for enhancing task- oriented therapy of the upper limb. However, for the lower limb little is known regarding the role of the brain in gait recovery. The objective of this study is to develop a novel therapeutic intervention that is based on understanding neural adaptations to enhance gait in stroke survivors. In this study we propose that cortical priming combined with ankle motor control training is expected to improve volitional control of the paretic ankle and will enhance the beneficial effects of gait training. In this experiment, moderate to severely impaired post- stroke individuals will receive a fast treadmill training (FTT) protocol following the administration of one of three priming paradigms: facilitatory tDCS in combination with an ankle motor training task (tDCS-AMT), sham tDCS in combination with an ankle motor training task (sham-AMT) or facilitatory tDCS during rest (tDCS-rest). In addition, a control group of patients (CONT) will participate in the FTT protocol in the absence of any priming intervention.
Aim 1 will identify the effectiveness of tDCS-AMT on gait speed, gait symmetry and ankle range of motion.
Aim 2 will determine the effectiveness of tDCS-AMT on corticospinal mechanisms as measured by transcranial magnetic stimulation (TMS).
Aim 3 will determine the effectiveness of tDCS-AMT on paretic ankle motor control and functional outcomes. With our mechanistic approach to enhance function, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms and functional recovery. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is relevant to the mission of the NIH.

Public Health Relevance

Over four million stroke survivors currently living in the United States are unable to walk independently in the community. To increase the effectiveness of gait rehabilitation, it is critical to develop therapies that are based on an understanding of brain adaptations that occur after stroke. This project will be the first step towards the development of a novel therapeutic approach using brain stimulation to increase walking capacity in stroke survivors and understand the neural mechanisms that are associated with impairment and functional recovery.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Nitkin, Ralph M
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University of Illinois at Chicago
Other Health Professions
Schools of Allied Health Profes
United States
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David, Fabian J; Goelz, Lisa C; Tangonan, Ruth Z et al. (2018) Bilateral deep brain stimulation of the subthalamic nucleus increases pointing error during memory-guided sequential reaching. Exp Brain Res 236:1053-1065
Sivaramakrishnan, Anjali; Madhavan, Sangeetha (2018) Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors. Stroke 49:2004-2007
Madhavan, Sangeetha; Stoykov, Mary Ellen (2017) Editorial: Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives. Front Neurol 8:448
Stoykov, Mary Ellen; Corcos, Daniel Montie; Madhavan, Sangeetha (2017) Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav 49:88-97
Madhavan, Sangeetha; Bishnoi, Alka (2017) Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke. Top Stroke Rehabil 24:579-584
Madhavan, Sangeetha; Stinear, James W; Kanekar, Neeta (2016) Effects of a Single Session of High Intensity Interval Treadmill Training on Corticomotor Excitability following Stroke: Implications for Therapy. Neural Plast 2016:1686414
Sivaramakrishnan, Anjali; Tahara-Eckl, Lenore; Madhavan, Sangeetha (2016) Spatial localization and distribution of the TMS-related 'hotspot' of the tibialis anterior muscle representation in the healthy and post-stroke motor cortex. Neurosci Lett 627:30-5
Devanathan, Daya; Madhavan, Sangeetha (2016) Effects of anodal tDCS of the lower limb M1 on ankle reaction time in young adults. Exp Brain Res 234:377-85
Madhavan, Sangeetha; Sriraman, Aishwarya; Freels, Sally (2016) Reliability and Variability of tDCS Induced Changes in the Lower Limb Motor Cortex. Brain Sci 6:
Nguyen, Tai Tri; Ugwu, John; Madhavan, Sangeetha (2015) Anodal tDCS of the lower limb M1 does not acutely affect clinical blood pressure and heart rate in healthy and post stroke individuals. SOJ Neurol 2:

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