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Title: Modulation of sensorimotor and perceptual components of balance in disease
Author: Lee, Pei-Yun
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2013
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Balance disorders are common in many neurological diseases. Well-controlled balance requires all balance systems, including visual, vestibular, and somatosensory system, providing specific information about position and motion of the body and the motor system executing appropriate strategies. The aim of the thesis is to apply modulation of visual, vestibular, and somatosensory systems in order to develop new treatments for balance disorders. In this thesis, two types of balance disorders were investigated separately: i) Parkinson's disease (PD), caused by central nervous system neurodegeneration, and ii) vestibular disorders, caused by peripheral vestibular dysfunction. Both patients groups experience difficulties in postural control. In order to determine an efficient therapeutic method to improve their balance function, the efficacy of different assistive techniques, treatments, and physiotherapy on performance was examined in the two patients groups. First, characteristics of protective stepping response in healthy young and elderly adults were examined. Participants were tested on a moving platform prompting a protective step to characterise their forward and backward stepping responses. Second, characteristics of protective stepping response in PD patients were described. Use of vibrotactile feedback on protective stepping response was also tested to investigate its effect on enhancing the stepping response in PD patients via the somatosensory system. Third, non-invasive brain stimulation, transcranial direct current stimulation (tDCS), incorporated with physiotherapy was applied on PD patients to investigate its effect on protective stepping response via changing corticomotor excitability. The last part of the thesis, intensive visual motion stimulation incorporated within a customised exercise programme was provided to patients with peripheral vestibular disorders and visual vertigo, whereby patients experience symptom provocation or exacerbation when exposed to busy visual motion environments (i.e. crowds) to investigate whether this intensive programme could enhance improvement of subjective visual vertigo symptoms and objective perceptual and postural measures of visual dependency. In general, the efficacy of different assistive techniques and treatment schemes on balance control in patients with PD or vestibular disorders was studied. The outcome of different treatment techniques will be presented in the thesis.
Supervisor: Bronstein, Adolfo ; pavlou, Marousa Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available