Post-stroke rehabilitative mechanisms in individualized fatigue level–controlled treadmill training in rats

Clinically, individualized training improves post-stroke motor function rehabilitation efficiency. However, the mechanisms underlying how individualized training facilitates recovery remain relatively unclear. Here, we explored the cortical and corticomuscular rehabilitative effects of post-stroke motor function recovery during individualized training using a rat model of intracerebral hemorrhage. Forced training or individualized fatigue-controlled training was provided from days 2 to 14 post-stroke. The fatigue-controlled training group exhibited superior motor function recovery and less central fatigue compared with the forced training group. Electroencephalograph power spectrum density slope analysis demonstrated better inter-hemispheric balance in the fatigue-controlled training group than in the forced training group. Directed corticomuscular coherence analysis indicated that training-induced fatigue led to a short-term downregulation of descending directed corticomuscular coherence and an upregulation of ascending directed corticomuscular coherence. In the long term, excessive fatigue hindered the recovery of descending control in the affected hemisphere. In conclusion, the individualized strategy of peripheral fatigue-controlled training achieved better motor function recovery, which may be attributed to the mitigation of central fatigue, optimization of inter-hemispheric balance, and enhancement of descending control in the affected hemisphere. This is the first study to investigate the mechanisms underlying individualized rehabilitative effects at the cortical and corticomuscular levels. Our findings suggest that personalized training protocols that are tailored to manage fatigue levels may substantially enhance post-stroke motor efficiency. They also provide a mechanistic foundation for developing fatigue-monitored, individualized rehabilitation programs in clinical practice.