Translational Methods for Non-Invasive Electrical Stimulation to Facilitate Gait Rehabilitation Following Stroke - The Future Directions
Anirban Dutta, Walter Paulus and Michael A. Nitsche
Affiliation: Department of Clinical Neurophysiology of Georg-August-University, Robert-Koch-Strabβ 40, Gottingen, Germany D-37075.
Stroke is one of the leading diseases of the ageing world population where about half of the stroke survivors are
left with some degree of physical or cognitive impairment. Impairment of walking is mentioned most frequently as the
most important disability. Furthermore, reduced locomotor mobility worsens metabolic fitness, which is one of the leading
factors of morbidity in these patients, and imposes an enormous economic burden. Therefore, innovative methodologies
for stroke neurorehabilitation are required to reduce long-term disability by physiologically-relevant and evidencebased
treatments. With regard to motor rehabilitation, neuroplasticity, which is the ability of the nervous system to respond
to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections is of utmost importance for
re-gaining functions. Post-stroke neuroplasticity can be facilitated with non-invasive multi-level electrotherapy such as
neuromuscular electrical stimulation (NMES) and noninvasive brain stimulation (NIBS), thus improving restitution of locomotor
function and alleviating the burden of stroke. In this connection, the translation of insights gained from animal
and human basic studies to address the complexity of rational multi-level electrotherapy protocols and to customize such
novel electrotherapy protocols, which has only recently become possible with advanced computational tools, is an important
challenge. Advanced computational modeling to design and customize innovative electrotherapy protocols to patientspecific
needs might help to reach this aim. Here, we provide an overview of the computational methods available to drive
individualized multi-level non-invasive electrotherapy programs for gait therapy following stroke based on rationale insights
gained from neurophysiological studies.
Keywords: Gait therapy, myoelectric control, neuromuscular electrical stimulation, operant conditioning, stroke, transcranial
direct current stimulation.
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