Transforming neurorehabilitation of walking following stroke: The promise of non-invasive brain stimulation - A review

Purpose: This narrative review discusses the neurophysiology of human motor cortex as it influences gait, and recent advances in the application of non-invasive brain stimulation to the lower limb motor cortex of stroke survivors. Although walking is a high priority following stroke, the efficacy of promising new therapies has yet to warrant their widespread clinical use. For the upper limb, numerous brain stimulation protocols have been described. These protocols, adapted for the leg, are now being used to examine the cortical control of gait. This research discounts the long-held notion that "we walk from our spinal cords". Methods: Our review describes this research as it relates to the lower limb, especially the use of non-invasive brain stimulation to enhance neuroplasticity. The review also discusses the possible development of a prognostic algorithm for walking recovery after stroke. Conclusion: This review concludes with the expectation that novel brain stimulation protocols combined with therapy will eventually demonstrate a level of effectiveness sufficient to promote their wide acceptance in neurorehabilitation settings.