Post-task resting-state fMRI of walking-related neural activity in patients with stroke: immediate and delayed brain network dynamics

Background Walking impairments post-stroke are common but studying their neural basis with fMRI is difficult due to motion constraints. This study used post-task resting-state residual activity (PTRRA) to investigate walking-related neural activity without in-scanner movement.Methods Ten patients with subcortical ischemic stroke and ten matched healthy controls underwent two resting-state fMRI sessions: one immediately after overground walking, and another after a 20-minute delay. Clinical assessments included Fugl-Meyer Assessment and Timed Up-and-Go Test (TUGT). Analyses included ALFF, functional connectivity (FC), and graph theory.Results Significant group × time interactions showed that stroke patients had increased ALFF in the contralesional primary somatosensory cortex (S1) during the delayed session. This increase inversely correlated with TUGT scores (r = –0.677, p = 0.032). Enhanced FC was found between contralesional S1 and ipsilesional sensorimotor regions. ALFF changes and bilateral S1 FC were significantly associated with mobility outcomes. Graph theory results were atlas-dependent.Conclusion Increased contralesional S1 activation and its enhanced connectivity with bilateral motor areas may reflect adaptive changes supporting post-stroke balance. The PTRRA method proved feasible for capturing post-walk neural activity and may be useful for assessing large-scale network dynamics after stroke.