Neuromodulation of lower limb monoparesis: functional electrical therapy of walking

After Cerebro-Vascular Accident (CVA), restoration of normal function, such as locomotion, depends on reorganization of existing central nervous system (CNS) circuitry. This capacity for reorganization, generally referred to as plasticity, is thought to underlie many instances of functional recovery after injury as well as learning and memory in the undamaged CNS. Both the reorganization of the supraspinal and spinal circuitry are highly important for the recovery of walking. The neural mechanisms responsible for learning and adapting processes are thought to involve changes both in the efficacy of synaptic function and the pattern of synaptic connections within neural circuits. In the uninjured CNS, these changes occur as a result of alterations in the amount of neural activity within circuits and are, therefore, termed activity-dependent. In this chapter, we will present several therapies of walking that provide effective input for the training of the existing CNS circuitry; thereby, contribute to long term recovery of sensory-motor functions. The focus of this chapter is Functional Electrical Therapy (FET) of walking, that is, the multi-channel electrical stimulation of sensory-motor systems that lead to more normal stance and swing of the paretic leg during the walking exercise.