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Original research
Do lower limb motor-evoked potentials predict walking outcomes post-stroke?
  1. Marie-Claire Smith1,2,
  2. Benjamin J Scrivener2,3,
  3. Cathy M Stinear2
  1. 1 Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
  2. 2 Department of Medicine, The University of Auckland, Auckland, New Zealand
  3. 3 Neurology, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Prof Cathy M Stinear, Department of Medicine, The University of Auckland, Auckland 1142, New Zealand; c.stinear{at}


Background This observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and 6 months post-stroke.

Methods Non-ambulatory participants were recruited 5 days post-stroke. Transcranial magnetic stimulation was used to determine tibialis anterior MEP status and clinical assessments (age, National Institutes of Health Stroke Scale (NIHSS), ankle dorsiflexion strength, LL motricity index, Berg Balance Test) were completed 1 week post-stroke. Functional Ambulation Category (FAC), use of AFO and walking aid were assessed 3 months and 6 months post-stroke. MEP status, alone and combined with clinical measures, and walking outcomes at 3 and 6 months were analysed with Pearson χ2 and multivariate binary logistic regression.

Results Ninety participants were included (median age 72 years (38–97 years)). Most participants (81%) walked independently (FAC ≥ 4), 17% used an AFO, and 49% used a walking aid 3 months post-stroke with similar findings at 6 months. Independent walking was better predicted by age, LL strength and Berg Balance Test (accuracy 92%, 95% CI 85% to 97%) than MEP status (accuracy 73%, 95% CI 63% to 83%). AFO use was better predicted by NIHSS and MEP status (accuracy 88%, 95% CI 79% to 94%) than MEP status alone (accuracy 76%, 95% CI 65% to 84%). No variables predicted use of walking aids.

Conclusions The presence of LL MEPs 1-week post-stroke predicts independent walking at 3 and 6 months post-stroke. However, the absence of MEPs does not preclude independent walking. Clinical factors, particularly age, balance and stroke severity, more strongly predict independent walking than MEP status. LL MEP status adds little value as a biomarker for walking outcomes.


Data availability statement

Data are available on reasonable request. All data are available on reasonable request.

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Data availability statement

Data are available on reasonable request. All data are available on reasonable request.

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  • Contributors M-CS and CMS conceived and designed study. M-CS and BJS collected clinical and neurophysiological data. M-CS and CMS analysed data and drafted paper. All three authors revised and finalised paper. CMS is guarantor.

  • Funding Health Research Council New Zealand (11/270); Neurological Foundation of New Zealand (1735-PG); Auckland Academic Health Alliance (3715213); Julius Brendel Trust.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.