Post-Stroke Corticomotor Drive to the Lower Extremity

POST-STROKE CORTICOMOTOR DRIVE TO THE LOWER EXTREMITY: RELATIONSHIP TO FUNCTIONAL RECOVERY AND RESPONSES TO FUNCTIONAL ELECTRICAL STIMULATION

Jacqueline Palmer, Ph.D. University of Delaware Newark, DE

ABSTRACT: Despite current standard rehabilitation efforts, walking deficits that contribute to limitations in activity and participation in individuals with chronic stroke persist. Previous research has identified key biomechanical factors that limit post-stroke walking speed and, when improved through rehabilitation, enhance functional ambulation. However the neurophysiologic mechanisms underlying highly variable post-stroke biomechanical strategies are unknown. There is recent evidence that corticomotor input to the paretic arm and hand of individuals post-stroke is related to functional performance, can be changed through motor learning, and can predict functional outcomes in response to intervention. The strength of corticomotor input to muscles of the paretic and nonparetic leg following stroke has been less thoroughly researched, but may provide valuable insight into neurophysiologic mechanisms underlying post-stroke walking recovery. Additionally, positive changes in corticomotor input to the lower extremity could translate to improved functional ambulation. The overall purpose of this project is to explain neurophysiologic mechanisms underlying lower extremity clinical function (aim 1) and biomechanical outcomes (aim 2) following stroke, and to investigate corticomotor responses and the ability to predict the effect of a rehabilitation session utilizing functional electrical stimulation (FES) with gait training on changes biomechanical measures (aim 3). Results of this work will enhance our current understanding of the neurophysiologic processes underlying motor recovery of the lower extremity following stroke and is a first step towards providing guidance for future rehabilitation efforts focusing on individual patient deficits and maximizing functional recovery of ambulation through appropriate targeted interventions. ______

Jacqueline Palmer is a physical therapist and neuroscientist with a strong clinical background using laboratory research to apply to clinical settings in neurologic rehabilitation. She received her Doctor of Physical Therapy (DPT) degree in 2013 and is currently working towards completion of her PhD in Biomechanics and Movement Science at the University of Delaware (UD), Newark, DE. Her research focuses on the investigation of neurophysiologic and biomechanical factors underlying motor control and recovery of walking, primarily in individuals post-stroke. Early in her career she has published 5 peer-reviewed articles in journals that include Journal of Neurophysiology and Neurorehabilitation and Neural Repair and received 6 professional awards including a Professional Student Research Award from the APTA's Neurology Section and a PODs Level II scholarship from the Foundation of Physical Therapy. In addition to her research, Jacqueline also instructs the Electrotherapy laboratory course in UD's DPT program and serves as a part-time treating physical therapist and clinical instructor in UD's Neurologic and Older Adults clinic. Her long-term professional goals are enhance the understanding of motor control and recovery in a way that provides clinicians with tools and guidelines that will help individualize patient treatment and maximize the effectiveness of rehabilitation in neurologic patient populations.