Novel interventions to promote neural plasticity and improve functional movement of the upper limb following stroke

• Main Author: Buick, Alison Ruth
• Published: Queen's University Belfast 2015
• Subjects: 616.8
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.680502

Neuromuscular electrical stimulation (NMES) may play a role in the restoration of motor function for chronic stroke survivors suffering from hemiparesis of the upper extremity. Stimulation delivered to paretic muscle that gives rise to functionally useful contractions (functional electrical stimulation or FES) may enable a previously quiescent 11mb to perform purposeful tasks. In addition to this directly functional role, electrical stimulation may also be used therapeutically as it has the potential to induce lasting adaptation within central motor networks. This thesis provides a literature review and subsequent empirical data to identify key factors In relation to the delivery of NMES that maximise the therapeutic potential, pairing it with movement-based interventions as a means of driving neuroplastic adaptation and recovery of motor function. A major aim was to identity rehabilitative strategies accessible to more severely affected stroke survivors in the chronic stages of the disease. The experimental chapters tested two types of electrical stimulation paired with an additional movement-based strategy: peripheral afferent electrical stimulation delivered at sub-motor threshold as part of an experimental associative paradigm designed to promote neuroplastic adaptation In healthy adults (chapter 2); and FES used to assist and maximise voluntary movement of stroke survivors taking part in a program of exercise therapy (chapter 3). This body of work suggests that whilst NMES may play a role in the recovery of motor function when used as an adjunct to Interventions that require considerable voluntary activation, careful consideration of the optimal pairings must be done before implementing it as an established rehabilitative strategy. Stimulation that is sub-motor threshold may be less beneficial than using supra-motor stimulation that has a larger Impact on the motor networks involved and also has functional utility.