Sustained prefrontal activation during ataxic gait: a compensatory mechanism for ataxic stroke?

There is accumulated evidence that cortical reorganization plays an important role in motor recovery after supratentorial stroke. However neural mechanisms underlying functional recovery of ataxia after infratentorial stroke remain unclear. We investigated cortical activations during ataxic gait in patients with infratentorial stroke to test the hypothesis that cerebral cortices were involved in compensatory mechanisms for ataxic gait. Twelve patients with infratentorial stroke (mean duration+/-S.D. from the onset: 88.3+/-44.8 days) and 11 age-matched healthy subjects participated in this study. All patients had predominant ataxia without severe hemiparesis. We measured cortical activation as assessed by task-related increase of oxygenated hemoglobin during gait on a treadmill using functional near-infrared spectroscopy. Task consisted of three repetitions of gait period alternated with rest period. In controls, cortical activations in the lateral and medial prefrontal cortex during the acceleration phase tended to be attenuated during the steady phase of the gait period while these activations were sustained throughout the gait period in ataxic patients. Repeated measures ANOVA for cortical activation revealed significant interactions (p<0.005) between phase (acceleration/steady) and group (control/stroke) in the medial and lateral prefrontal regions. These results suggest that sustained prefrontal activation during ataxic gait might be relevant to compensatory mechanisms for ataxic gait after infratentorial stroke.