published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2012.

The present thesis examines the effects of transcranial direct current stimulation and forelimb rehabilitation on motor recovery after stroke in rats. Post-stroke motor outcomes were quantified using an innovative battery of behavioural tests and high resolution, in vivo electrophysiology was employed to examine coherence of neural activity between hemispheres. It was shown that rats that received brain stimulation concurrently with forelimb rehabilitation displayed functional recovery, whereas rats that received rehabilitation alone partially regained motor function, but the improvements were not due to restitution of original movement patterns. Results from electrophysiological recordings showed that rats that received brain stimulation and rehabilitation regained pre-stroke levels of interhemispheric coherence, but rats that received rehabilitation alone did not. The present thesis suggests that transcranial direct current stimulation may be a viable adjunct therapy to increase the efficacy of physical rehabilitation with regard to post-stroke motor outcomes. Interhemishperic coherence between homotopic neuronal populations may represent a biomarker of genuine motor recovery after stroke. / ix, 75 leaves : col. ill. ; 29 cm