PhD ThesisInnovation is required to improve upper limb rehabilitation for neurological conditions such as
stroke and spinal cord injury (SCI). There is growing appreciation of the importance of neural
plasticity in recovery, and how this can be facilitated by synchronous activity in peripheral
neural circuits and central brain areas. However, despite increasing scientific evidence,
technological solutions that exploit associative plasticity have not yet been widely evaluated in
clinical practice.
In this thesis, I report the development and initial evaluation of a novel device which enabled
a reaching and grasping motion in the affected limb by combining assistive functional electrical
stimulation (FES) with inferred voluntary brain activity. The device was designed to enable
translation from laboratory-to-clinic by overcoming common practical barriers to translational
research, such as adaptability and ease of use.
The device was demonstrated to be usable by individuals with either chronic stroke or SCI, and
received positive qualitative feedback. Some participants showed modest improvements on
assessments of upper limb function following a short intervention period.
A study with healthy able-bodied volunteers indicated that after using the device, corticospinal
pathways to the antagonist (flexor) muscle may be facilitated, and this facilitation might be
increased by adjusting the relative timing of stimulation and inferred brain activity.
The device could also deliver alternative stimulation techniques, and an exploratory study into
transcutaneous spinal cord stimulation (tSCS) was conducted with healthy able-bodied
volunteers. It was found that tSCS may activate peripheral and spinal pathways within
acceptable comfort levels, but the parameters used in this study did not to generate functional
contractions. An unexpected oscillatory motor response provided insights into how tSCS acts
upon the motor system.
Prior to a large scale evaluation of clinical effectiveness, further research is required to: further
develop a theoretical basis for the intervention; demonstrate the mechanisms of action; and to
evaluate the efficacy of the device.Wellcome Trust, postgraduate research studentship (2015 to 2018)
• EPSRC Preparing for GCRF Award (PI: Dr Andrew Jackson) - Low cost
rehabilitation of hand function following stroke (2016 to 2017
