Evaluation of changes in the cortical gait control in post-stroke patients induced by the use of the 'Regent' soft exoskeleton complex (SEC) by navigated transcranial magnetic stimulation

The mechanisms underlying the locomotion recovery in poststroke patients remain unknown. Navigated transcranial magnetic stimulation (nTMS) is a new method to evaluate the functional state of the motor system. Using of the “Regent” soft exoskeleton complex (SEC) allow to correct walking pattern significantly. The aim of this study was to evaluate the capability of nTMS to assess changes in gait cortical control using SEC in poststroke patients. 14 patients of the subcortical stroke (the mean age was 53.0 years, the mean time from stroke onset was 14.2 months) received 10 training sessions with SEC. The patients received nTMS before and after the sessions, as well as they were clinically evaluated by the Fugl–Meyer scale section for lower extremity and a 10-m walk test. Whereas a reliable reduction in the time of walking for 10 m was recorded after the sessions with the application of SEC, the Fugl-Meyer scale assessment remained unchanged. During nTMS, a reduction was recorded in the average latency of evoked motor response from the affected hemisphere, as well as various patterns of changes in the size and localization of cortical representations of the leg muscles. We have concluded that the nTMS method allowed us to identify the individual patterns of changes in the cortical representations of leg muscles as a result of the use of SEC in post-stroke patients with injuries in a group of locomotor system elements, thus identifying not only the fact of the undergoing neuroplastic processes, but also their direction.