Motor recovery from subcortial ischemic disease and its facilitation studied by functional MRI (fMRI)

Summary: A study of the physiological basis of performance gains with treadmill gait training in the chronic phase after subcortical ischaemic stroke. Functional MRI and clinical gait assessment would be used to ascertain the neurophysiological correlates of successful gait rehabilitation. Background: Multiple small strokes deep in the brain are a common cause of impaired walking in elderly people. This subcortical ischaemic injury to the white matter represents a major cause of disability with ageing. However, despite the importance of walking particularly for the maintenance of independency and self-care capacities, the brain mechanisms of gait in health as well as in disease in the elderly are not well understood. Methods: We would use functional magnetic resonance imaging (FMRI) to compare the neural control of gait in healthy elderly subjects and younger subjects. This special method of brain scanning is completely safe and painless and allows to visualize activity in the brain of volunteers as it occurs. Aims: In the first part of the project, we would try to discover how the brain controls gait in the elderly as compared with younger subjects. In the second part, we would aim to investigate the effects of intensive walking training (using a treadmill) on the functional organisation of motor control in elderly patients with gait impairment from subcortical ischaemic disease. This study would therefore test the effectiveness of this intensive gait rehabilitation for treating mobility problems in patients who have had strokes and the potential practical application of this new imaging method. Such results would help to establish a neurobiological foundation for gait rehabilitation therapy and test the potential of fMRI as a quantitative measure of rehabilitation effects.