Motor and Neurophysiological Effects of Ischemic Conditioning (IC) and Tele-Based IC in Chronic Stroke

This dissertation examines the influence of ischemic conditioning (IC) on motor and neurophysiological outcomes in individuals with chronic stroke. Using neurophysiological measures to evaluate corticomotor excitability and transcallosal inhibition (TCI), these studies tested whether IC and tele-based ischemic conditioning (tele-IC) modulate corticomotor activity and motor performance. A single session of IC revealed distinct enhancements in ipsilesional corticomotor excitability and ipsilesional-to-contralesional TCI, accompanied by improvements in paretic strength and motor control. These findings demonstrate the acute neuromodulatory effects of IC, though validation in larger cohorts is needed. Building on these results, a novel tele-IC paradigm—comprising seven remotely delivered sessions over two weeks—was found to be safe, feasible, and effective for individuals with chronic stroke. The intervention showed excellent adherence, minimal adverse effects, and high participant satisfaction, along with promising gains in neurophysiological and motor outcomes. Specifically, two weeks of tele-IC enhanced ipsilesional-to-contralesional TCI, bilateral strength, and paretic motor control. Notably, approximately half of the participants exhibited substantial increases in corticomotor excitability and paretic knee extensor strength, allowing identification of a responder subgroup to tele-IC. Collectively, these findings highlight the neuromodulatory potential of blood flow modulation, indicating that IC may serve as a novel strategy to promote neurophysiological and motor recovery post-stroke. By advancing mechanistic understanding of IC, this work underscores the clinical relevance of cyclical blood flow modulation to promote neuroplasticity and functional rehabilitation both acutely and across multiple sessions. Importantly, the heterogeneity observed among participants, particularly within the tele-IC responder subgroup, emphasizes the possible need for personalized approaches to neuromodulation. Overall, this dissertation provides foundational evidence that both acute IC and multi-session tele-IC represent scalable, low-burden, and individualized neuromodulatory approaches to enhance lower limb motor recovery after stroke. These findings support the need for future randomized controlled trials with larger samples to optimize IC protocols, delineate responder profiles based on neurophysiological characteristics, and evaluate dosing, durability, and combination strategies to maximize recovery outcomes.

Author dc:creator

• Mark Cummings (21075007)

• Neurorehabilitation
• Biology, Neuroscience

Statement dc:rights

• In Copyright

DOI dc:identifier

https://doi.org/10.25417/uic.31451305.v1

OAI identifier oai:identifier

oai:figshare.com:article/31451305