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Neuromodulation in the treatment of upper limb spasticity

Massey, Sarah; (2021) Neuromodulation in the treatment of upper limb spasticity. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

In this thesis I investigated neurophysiological changes following transcutaneous electrical nerve stimulation (TENS) at 100 Hz, and TENS and transcutaneous spinal cord stimulation (tSCS) applied with high-frequency (10 kHz) trains (HF-TENS and HF-tSCS, respectively). I also assessed literature studying neuromodulation for spasticity in SCI and developed a mobile application (app) which aimed to improve spasticity self-management through education of triggers. Paired-pulses of cervical tSCS caused post-activation depression in posterior-root reflexes (PRRs) in wrist flexors and extensors at interstimulus intervals of < 2 s; showing a similar pattern of modulation observed in previous studies with H-reflex activity (8 healthy, able-bodied participants). Another study compared TENS, HF-TENS and HF-tSCS to sham stimulation. Changes in PRRs and motor-evoked potentials (MEPs) in the wrist flexor and extensor were assessed. HF-tSCS was most efficient at modulating corticospinal excitability immediately after intervention, causing a decrease in flexor MEPs lasting 30 minutes (p = 0.015), as well as a trend towards an increase in extensor MEPs. Late spinal inhibition of wrist flexors occurred following 60 minutes of HF-tSCS (p = 0.018). An app was designed to support users in identifying factors which trigger their spasticity by logging and rating events (Penn spasm frequency scale). The design of the app was assessed using questionnaires sent to clinicians and people with spasticity. Results showed that all responders felt that the design of the app could have potential in benefitting symptoms of spasticity. Bringing together neurophysiological and clinical measures of spasticity, a systematic review and meta-analysis of 27 studies assessed the effects of neuromodulation on spasticity in SCI. This revealed a lack of randomised control trials (RCTs). In 3 RCTs and 17 studies without a control group, there was a reduction in spasticity immediately following electrical stimulation according to clinical measures. Four studies included the H-reflex as an outcome measure, with 3/4 reporting no change, or varied results between participants.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Neuromodulation in the treatment of upper limb spasticity
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
URI: https://discovery.ucl.ac.uk/id/eprint/10134276
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