Neural control of gait: clinical neurophysiological aspects

From the three essential mechanisms in locomotion, the antigravity, equilibrium and stepping mechanisms, only the latter is specific for gait. The spinal cord is considered to be a central pattern generator in experimental animals and is under the influence of different afferent sources and descending impulses. In clinical practice locomotor mechanisms can be modified at peripheral levels, as with functional electrical stimulation of peripheral nerves, and at the spinal cord, as in spinal cord stimulation, and theoretically also at midbrain and subthalamic locomotor areas. The importance of the spinal cord pattern generator in spinal cord injured patients is discussed. The role of postural mechanisms in locomotion is emphasized.