Using Stimulation and Repetitive Task Practice to Promote Neuroplasticity Targeted at Improving Hand Function in Individuals with Chronic Tetraplegia.

摘要: of a dissertation at the University Miami. Dissertation supervised by Edelle Field-Fote, Ph.D, P.T. No. pages in text. (118) Injury to cervical segments spinal cord causes significant functional deficits upper extremities, affecting performance daily life activities and quality life. Functional impairments following injury (SCI) are primarily attributed damage ascending descending tracts that hinders flow information from supraspinal centers hand muscles, but there is also evidence post-injury patterns cortical reorganization can play an important role. This thesis explored influence different approaches used activate motor cortex combined with repetitive task practice, assessed their effects on function corticomotor excitability. In chapter 1, we literature regarding primary processes (the lesion itself) secondary (cortical anatomical changes) may further contribute after tetraplegia. addition, use stimulation either target directly (repetitive transcranial magnetic [rTMS] direct current [tDCS]), or indirectly (transcutaneous electrical nerve [TENS] peripherally applied vibration [VIB]) for excitability thus, potential as adjunct tools neurorehabilitation. study described 2, safety late multi-day intervention consisting novel electrode montage using tDCS aimed increasing bihemispheric (and targeting bimanual observed SCI activation exists movements) interleaved typing neurologically healthy participants. We found 5 days BAC-tDCS was associated significantly greater gains when compared sham-tDCS, which not retained one week. 3, describe where 3-day 10 Hz rTMS (a frequency increased excitability) fine individuals tetraplegia controls. participants who received made improvements skilled Jebsen-Taylor Hand Function Test grasp force than sham-rTMS. The improvement accompanied changes pinch grip Chapter 4, undertook assess whether differences outcomes practice each clinically accessible increase (tDCS) (TENS, VIB) . Individuals participated this crossover session approach, simultaneously delivered practice. transient increases VIB condition, measured Nine-hole Peg TENS conditions. seemed have shared similarities terms early excitability, whereas follow pattern characterized Finally, explore discuss results these studies applicability extremity rehabilitation