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BackgroundRecovery of walking post-stroke is highly variable. Accurately measuring and documenting functional brain activation characteristics during walking can help guide rehabilitation. Previous work in this area has been limited to investigations of frontal brain regions and have not utilized recent technological and analytical advances for more accurate measurements. There were three aims for this study: to characterize the hemodynamic profile during walking post-stroke, to investigate regional changes in brain activation during different phases of walking, and to related brain changes to clinical measures.MethodsFunctional near-infrared spectroscopy (fNIRS) along the pre-frontal, premotor, sensorimotor, and posterior parietal cortices was used on twenty individuals greater than six months post-stroke. Individual fNIRS optodes were digitized and used to estimate channel locations on each participant and short separation channels were used to control for extracerebral hemodynamic changes. Participants walked at their comfortable pace several times along a hallway while brain activation was recorded. Exploratory cluster analysis was conducted to determine if there was a link between brain activation and clinical measures.ResultsSustained activation was observed in the pre-frontal cortex with the ipsilesional hemisphere showing greater activation compared to the contralesional side. Sensorimotor cortex was active during the early, acceleration stage of walking only. Posterior parietal cortex showed changes in activation during the later, steady-state stage of walking. Faster gait speeds also related to increased activation in contralesional sensorimotor and posterior parietal cortices. Exploratory analysis clustered participants into two distinct groups based on their brain activation profiles and generally showed that individuals with greater activation tended to have better physical outcomes.ConclusionsThese findings can guide future research for obtaining adequate power and determining factors that can be used as effect modifiers to reduce inter-subject variability. Overall, this is the first study to report specific oxygenated and deoxygenated hemoglobin changes in frontal to parietal regions during walking in the stroke population. Our results shed light on the importance of measuring brain activation across the cortex and show the importance of pre-frontal, sensorimotor, and posterior parietal cortices in walking after a stroke.

Additional file 1. The table provided shows where each implementation strategy is mapped to one or more broad strategy from the Consolidated Framework for Implementation Research (CFIR) - Expert Recommendations for Implementing Change (ERIC) Strategy Matching Tool.

Additional file 1. Fugl-Meyer Lower Extremity Assessment for Telerehabilitation (FM-tele).

Additional file 3. Assessor questionnaire.

Additional file 3. Assessor questionnaire.

Additional file 2. Participant questionnaire.

Supplemental Material, sj-pdf-1-nnr-10.1177_15459683211062894 for Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap by Sue Peters, Tara Klassen, Amy Schneeberg, Sean Dukelow, Mark Bayley, Michael Hill, Sepideh Pooyania, Jennifer Yao and Janice Eng in Neurorehabilitation and Neural Repair

PRISMA-P checklist. This file (.docx) contains the completed PRISMA-P checklist. (DOCX 33 kb)

Search strategy for MEDLINE Ovid. This file (.docx) contains the search strategy for MEDLINE Ovid. (DOCX 14 kb)

PRISMA-P checklist. This file (.docx) contains the completed PRISMA-P checklist. (DOCX 33 kb)

Search strategy for MEDLINE Ovid. This file (.docx) contains the search strategy for MEDLINE Ovid. (DOCX 14 kb)