Week Two

Question 1

What is neuromuscular electrical stimulation (NMES)?

Answer 1

• Application of pulsed electrical currents to muscles, nerves or neuromuscular junctions.
• Thought to benefit muscle strength, stamina and reaction time

Question 2

What are some limitations to NMES?

Answer 2

• More research is needed
• Under-explored potential for harm
• Administered by the clinician rather than performed by the patient (experience dependent plasticity)
• Training issues
• May cause decrease in pressure, hyoid movement
• Poor quality of research
• Inconsistent definition of the specific effects of NMES

Question 3

What is neuroplasticity

Answer 3

Any experience dependent enduring change in neuronal or network properties, either morphological or functional.

Anything you do or which happens to you that makes the brain change, either literally in its mass, or functionally (one part of the brain responsible for a behaviour moves to another part of the brain.

There are 5 main process in neuroplasticity

1. Axonial sprouting (axon regrows)
2. dendritic branching
3. Synaptogenesis
4. Neurogenesis
5. Gliogenisis

Neuroplasticity also responsible for spontaneous recovery.

Important for rehabilitative recovery

How it works: Axon of cell A fires and connects with cell b and learn to fire together. One part of the brain recruits the other area.

Question 4

What is Long-term potentiation and long-term depression?

Answer 4

How efficient the synapses are and how the message is sent between different neurons.

long-term potentiation = Repeating something constantly, the message can be sent more easily

Long-term depression = Not using a cell, the connection becomes weakened

Question 5

What are neuro-modulatory techniques?

Answer 5

Neuromodulatory techniques aim to regulate or normalize synaptic connectivity

These techniques are:
- Transcranial magnetic stimulation (TMS)
- Transcranial direct current stimulation (tDCS)

Question 6

What is transcrainal magnetic stimulation?

Answer 6

Transcranial magnetic stimulation is based on Faraday’s principles of electromagnetic induction.

Sends a magnetic pulse through the brain and “shakes” the neurons around.

Different frequencies can make the brain either more excited, or less excited.

Can be used as a diagnostic tool:
Single pulse - a pulse is sent out and a motor response is seen. This assesses the exitability od the corticobulbar motor projections, mapping the cortical motor representation of muscles, or studying motor conduction time

Paired pulse - Two stimuli are provided in close temporal sequence. How quickly you see the second pulse tells information about the pathway

But can also be used as a theraputic tool (Repetitive TMS):
- Can make either long-term potentiation or long-term depression happen. It depends on the overall number of pulses, frequency of stimuli and intensity of stimuli.

Question 7

What are some risks of rTMS?

Answer 7

• Not yet adequately explored, but potentially has effects on:
  Hearing
  Local pain and discomfort
  Seizures

Question 8

What is transcranial direct current stimulation (tDCS)?

Answer 8

There are two pads which are placed on the area of the brain you want to stimulate, the anodal pad excites and cathodal pad inhibits.

Electrical current is sent through and changes the resting potential of the neuron, either making it more or less likely to fire

Can be used both online (while swallowing) and offline (prior or following swallowing)

Question 9

What are clustered therapy protocols?

Answer 9

At the moment, it is suggested the greatest application of NIBS is to use these tools to excite the brain and then follow with bahavioural rehabilitation