There is a need for standardized clinically accessible measurements that would enable detection of the primary underlying deficit and a patient’s rehabilitation capacity after stroke. While a multitude of measures of neuromotor control exist, there is not a unified perspective on their complementarity versus redundancy for identifying the stroke-related impairments. This dissertation evaluates four measures of neuromotor control: the lower extremity portion of the Fugl-Meyer Assessment (FM-LE), plantarflexor central drive, the number of muscle synergies, and the dynamic motor control index. The first aim was to assess if the dynamic motor control index, which has not previously been used in a post-stroke population, could identify stroke-related impairments in neuromotor control, and how it compared to the number of muscle synergies. The second aim evaluated which measure(s) of neuromotor control were most indicative of biomechanics and functional outcomes. Twenty-two individuals post-stroke (60 ± 8 years old, chronicity 6 ± 4 years, 16 male, 10 right paretic) completed clinical assessments of the FM-LE and six-minute walk test, 90 seconds of fast treadmill walking during which force and muscle activity data were collection, and three burst-superimposition tests on the paretic limb for the calculation of central drive. The results of the first study concluded the dynamic motor control index was able to identify stroke-related impairments and may do so better than the discrete number of muscle synergies. The second study determined that the FM-LE, paretic central drive, and paretic dynamic motor control index are individually the best neuromotor indicator of propulsion asymmetry, endurance, and step time asymmetry, respectively, suggesting these measures are complementary for explaining post-stroke deficits. A multi-modal evaluation approach that combines these measures of neuromotor control with clinical and biomechanical evaluations provides the best opportunity to understand post-stroke walking impairment. Future work should focus on developing a single measure of neuromotor control that fully explains locomotor compensations and the primary underlying impairment, further enabling clinical accessibility and standardized assessments. / 2024-09-08T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46689 |
| Date | 08 September 2023 |
| Creators | Collimore, Ashley N. |
| Contributors | Awad, Louis N. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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