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Objective: To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. Design: A pilot randomized crossover trial. Setting: Two rehabilitation hospitals. Subjects: Twenty-two patients with subacute stroke. Interventions: Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Main measures: Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. Results: All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction ( P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01). Conclusion: Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.

BACKGROUND: Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone. OBJECTIVES: The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients. METHODS: Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA). RESULTS: The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT. CONCLUSION: ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions.

Galvanic vestibular stimulation (GVS) stimulates the vestibular system electrically with low-amplitude direct current through surface electrodes applied to the left and right mastoids. The effects of GVS on unilateral spatial neglect (USN) in poststroke patients were recently reported, but the influence of the current intensity and application duration of GVS on USN has not been sufficiently investigated. Here we explored the influence of these stimulus parameters on USN. We recruited seven patients with right-hemisphere stroke and left-sided USN (four female) for this single-blind, sham-controlled cross-over trial. Their scores on the line cancellation test were measured under three stimulation conditions [left-cathodal/right-anodal GVS (L-GVS), right-cathodal/left-anodal GVS, and sham] at three time points (before the start of GVS, 10 min after the start of GVS, and 20 min after the start of GVS). The GVS intensity was set below the sensory threshold and differed among the patients (0.4-2.0 mA). The cancellation scores were significantly increased after 10 and 20 min L-GVS, with a greater increase observed after the latter (P<0.0001). The other stimulus conditions had no significant effect. There was a significant positive correlation between the change in the increase in the cancellation score with L-GVS and the total charge (r=0.81, P=0.0004). The effect of GVS on USN may depend on its application duration, current intensity, and polarity.