Download files
Abstract
Stroke is a leading cause of disability with up to 83% of survivors suffering persistent hemiparesis. The only means to improve motor-function in the post-acute phase is with rehabilitation. The first study of this thesis investigated changes in proprioception at the elbow and wrist in comparison to healthy age- and sex-matched people. Differences in the magnitude and direction of perception varied with joint and motor-function status. This study emphasises the specificity of proprioception deficits and the need for quantitative testing for this input to motor control that may be independent of the reduced descending drive from the lesioned hemisphere. The subsequent studies investigated the physiological mechanisms of post-stroke recovery during Wii-based Movement Therapy (WMT) using wireless telemetry to record joint goniometry, lower-limb muscle activation and heart rate. Joint kinematics measured during therapy is the most direct measure of movement ability. Faster acceleration and peak deceleration reflected better movement control. Kinematic data were correlated with functional assessments measured pre- and post-therapy but not with active or passive range-of-motion, suggesting that range-of-motion is not a good test of functional improvements in chronic stroke. Lower-limb muscle activation was recorded bilaterally from tibialis anterior. Muscle symmetry and peak activation improved differently both within and between patients and WMT activities, and these correlated with improvements in lower-limb functional assessments. Finally, a post-hoc comparison between the cardiovascular responses with WMT and modified Constraint-Induced Movement Therapy (mCIMT) revealed a significant increase in peak heart rate and faster heart rate recovery time by late-therapy for WMT indicating increased cardiovascular fitness. Peak heart rate was always higher and heart rate recovery faster during mCIMT but neither changed by late-therapy, suggesting a sympathetic stress response to mCIMT activities that emphasise movement speed and high repetition rates. This thesis highlights the need for sensitive quantitative measures of post-stroke function. It is the first to report functional progress during an upper-limb therapy program. Finally, the results show that the functional capacity to improve post-stroke can be extended into the chronic period and that a targeted upper-limb protocol such as WMT can be multifactorial with ancillary lower-limb and cardiovascular benefits.