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Transcutaneous electrical stimulation (TNES) is a controversial treatment method for oropharyngeal dysphagia. Currently, few studies support the effectiveness of TNES for the treatment of dysphagia. This study examines the available research regarding the effectiveness of TNES for the treatment of oropharyngeal dysphagia. / text

This master’s report collected the available literature regarding the multiple treatment approaches for oropharyngeal dysphagia and the efficacy of each approach in the remediation of swallowing deficits. A variety of traditional intervention techniques are described and their efficacy data is presented, as well as limitations and contraindications to intervention. Efficacy data for modern oropharyngeal dysphagia intervention techniques such as Vitalstim and E-stim is also presented, and the differences between the two techniques are discussed. Ethical decision-making in dysphagia treatment is also discussed. / text

Research has shown that skeletal muscle, despite showing a high degree of specialisation, has a remarkable ability to modif,' its properties. Understanding these changes is important for optimal response to therapeutic intervention. These studies investigated alterations in neuromuscular performance of quadriceps femoris muscle in normal subjects, before investigating changes in muscle and neural mechanisms in the first six months following stroke. Muscle ftinction studies were conducted to monitor the effects of selected patterns of long term electrical stimulation (P1 - uniform 8 Hz, P2 - mixed frequency, and P3 random high and low frequency) on quadriceps femoris of2l healthy subjects. Stimulated muscles showed significant increases in strength, fatigue resistance and relaxation times after 3 weeks and in force-frequency output after 6 weeks. Significant changes were observed in the stimulated muscles in Groups P2 and P3 indicating that a mixed or random pattern of activation induced greater changes than a uniform 8 Hz pattern. These studies together with soleus H reflexes were used to study concurrent changes in quadriceps femoris and Ta spinal reflex pathways of stroke patients and age-matched controls (n=1O). One month following stroke, both paretic and non-paretic muscles were more fatiguable and weaker than the muscles of controls and disynaptic and presynaptic inhibition were reduced in the paretic limbs. In subsequent months, the paretic muscles regained strength and inhibitory effects were restored. Subjective analysis suggested that different patterns of recovery related to walking ability at six months. In patients taking less than 15s to walk lOm (Group 1 n=5), the paretic muscles became significantly stronger and less fatiguable over time whereas the muscles of patients who took longer to walk lOm (Group 2 n=5) remained weaker and more fatiguable. Reciprocal inhibition was regained by 1 month in Group 1 and by 6 months in Group 2. These findings provide insight into long-term recovery and rationale for therapeutic intervention following stroke.

Use of electrically stimulated exercise following spinal cord injury is recommended for improving fitness, and can be enhanced by the addition of upper limb exercise. Laboratory trials of electrically stimulated leg cycling (ESLC) have led to increased oxygen uptake and carbon dioxide production, and reactivation of the venous muscle pump, increasing stroke volume and cardiac output during exercise. However transfer of these eftects into home and community settings has been poor. The Power Trainer, a commercially available device, combines active arm crank exercise (ACE) with ESLC, achieving hybrid exercise (HE). Despite its relative simplicity compared with legs only electrical stimulation cycles, exercise responses associated with its use have not been researched. The exercising muscle mass during HE with the Power Trainer is increased compared with either arms only or legs only exercise, increasing respiratory demands. If venous return is also increased, such exercise will fulfil the requirements for regaining fitness following a spinal cord injury. Differences were investigated between the cardiorespiratory responses to ACE and HE on the Power Trainer. Responses were measured during 30 minutes of steady state exercise with each exercise modality.

Epilepsy, which manifests itself as spontaneous bouts of abnormal low complexity brain activity, is the second most common neurological disorder after stroke. This thesis explores the effect of variable frequency stimulation on seizure control. A responsive variable frequency electrical stimulation system is proposed and validated using a computational model capable of generating spontaneous seizure like events. The proposed stimulation system is demonstrated to outperform open-loop fixed frequency stimulation and responsive fixed frequency stimulation using seizure time based measures and a control energy measure.

Epilepsy, which manifests itself as spontaneous bouts of abnormal low complexity brain activity, is the second most common neurological disorder after stroke. This thesis explores the effect of variable frequency stimulation on seizure control. A responsive variable frequency electrical stimulation system is proposed and validated using a computational model capable of generating spontaneous seizure like events. The proposed stimulation system is demonstrated to outperform open-loop fixed frequency stimulation and responsive fixed frequency stimulation using seizure time based measures and a control energy measure.