Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke

Peurala, Sinikka H.; Pitkänen, Kauko; Sivenius, Juhani; Tarkka, Ina M.

doi:10.1191/0269215502cr543oa

Cited by 128 publications

(135 citation statements)

References 22 publications

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“…Using functional MRI in study with healthy subjects, Golaszewski et al 7 found that applying cutaneous electrical stimulation to the hand by a wire-mesh glove for 20 minutes produced increased blood flow in the primary sensory cortex as well as primary and secondary motor cortices. In another study with hemiparetic patients, Peurala et al 8 showed that cutaneous stimulation of the affected hand or foot by a glove electrode or a sock electrode twice daily, 20 minutes each time for 3 weeks, improved limb sensation and motor performance together with somatosensory evoked potential normality classification of the paretic limbs.…”

mentioning

confidence: 98%

Transcutaneous Electrical Nerve Stimulation Combined With Task-Related Training Improves Lower Limb Functions in Subjects With Chronic Stroke

Hui-Chan

2007

Stroke

129

137

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Background and Purpose-Previous studies have shown that repeated sensory inputs could enhance brain plasticity and cortical motor output. The purpose of this study was to investigate whether combining electrically induced sensory inputs through transcutaneous electrical nerve stimulation (TENS) with task-related training (TRT) in a home-based program would augment voluntary motor output in chronic stroke survivors better than either treatment alone or no treatment. Methods-Eighty-eight patients with stroke were assigned randomly to receive a home-based program of (1) TENS, (2) TENSϩTRT, (3) placebo TENSϩTRT, or (4) no treatment (control) 5 days a week for 4 weeks. Outcome measurements included Composite Spasticity Scale, peak torques generated during maximum isometric voluntary contraction of ankle dorsiflexors and plantarflexors, and gait velocity recorded at baseline, after 2 and 4 weeks of treatment, and 4 weeks after treatment ended. Results-When compared with TENS, the combined TENSϩTRT group showed significantly greater improvement in ankle dorsiflexion torque at follow-up and in ankle plantarflexion torque at week 2 and follow-up (PϽ0.01). When compared with placeboϩTRT, the TENSϩTRT group produced earlier and greater reduction of plantarflexor spasticity and improvement in ankle dorsiflexion torque at week 2 (PϽ0.01). When compared with all 3 groups, the TENSϩTRT group showed significantly greater improvement in gait velocity (PϽ0.01). Conclusions-In patients with chronic stroke, 20 sessions of a combined TENSϩTRT home-based program decreased plantarflexor spasticity, improved dorsiflexor and plantarflexor strength, and increased gait velocity significantly more than TENS alone, placeboϩTRT, or no treatment. Such improvements can even be maintained 4 weeks after treatment ended.

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confidence: 98%

Transcutaneous Electrical Nerve Stimulation Combined With Task-Related Training Improves Lower Limb Functions in Subjects With Chronic Stroke

Hui-Chan

2007

Stroke

129

137

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“…Previous studies predominantly recruited participants months or even years after stroke and therefore may have treated the late complications of stroke rather than influenced recovery. 15,33,36 We applied sNMES to the shoulder as models of upper limb recovery suggest that proximal precede distal changes. 37 The regime has been shown to be beneficial in previous studies 13,31 and is widely accepted in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke

Church

Price

Pandyan

et al. 2006

Stroke

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Background and Purpose— Surface neuromuscular electrical stimulation (sNMES) after stroke aims to improve upper limb function and reduce shoulder pain, but current evidence of effectiveness is inconclusive. We have undertaken a randomized controlled trial to evaluate sNMES to the shoulder after acute stroke. Methods— One hundred seventy-six patients, within 10 days of stroke onset, were randomized to receive sNMES or placebo in addition to stroke unit care. The primary outcome measure was upper limb function measured by the Action Research Arm Test (ARAT) 3 months after stroke. Secondary outcome measures included other measures of upper limb function, upper limb impairment, pain, disability, and global health status. Outcome assessments were blinded. Results— There was no difference in arm function between groups in terms of the primary outcome measure. The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group ( P =0.068). Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment: grasp and gross movement subsections of the ARAT, Frenchay Arm Test, and the arm subsection of the Motricity Index. Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness. Conclusions— A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients. “Routine” use of sNMES to the proximal affected upper limb after acute stroke cannot be recommended.

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“…The perceptual threshold for electrocutaneous detection on the thumb surface has been documented as 1.5mA delivered at 3Hz, producing a two point discrimination distance of approximately 5.6 ± 1mm [86], targeting both the FA-I and FA-II afferent receptors. Cutaneous electrostimulation has demonstrated positive effects on motor performance, limb sensation and the configuration of Sensory Evoked Potentials of the paretic limb in people with chronic stroke [87]. However, a high degree of variability in the perception of electrocutaneous stimuli has been reported, with qualitative reports of electrotactile sensations ranging from tingles to burning pain, depending on the voltage and current applied; this variability has also been reported in individual participants between sessions [87].…”

Section: Perception Of Electrocutaneous Stimulationmentioning

confidence: 99%

“…Cutaneous electrostimulation has demonstrated positive effects on motor performance, limb sensation and the configuration of Sensory Evoked Potentials of the paretic limb in people with chronic stroke [87]. However, a high degree of variability in the perception of electrocutaneous stimuli has been reported, with qualitative reports of electrotactile sensations ranging from tingles to burning pain, depending on the voltage and current applied; this variability has also been reported in individual participants between sessions [87]. One caveat in the use of this type of stimulation is that the distinction between detection of electrical stimulation and pain perception is, on average, only 15dB, which contrasts to a dynamic range of 60-80dB for vibrotactile stimulation [88].…”

Section: Perception Of Electrocutaneous Stimulationmentioning

confidence: 99%

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders

Demain

Metcalf

Merrett

et al. 2012

Disability and Rehabilitation: Assistive Technology

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 The current lack of emphasis on somatosensory rehabilitation may contribute to poor hand recovery in patients with central nervous system pathology.  Haptic technologies have the potential to improve sensation and sensory motor integration in neurological conditions  An underlying theoretical rationale is provided for the design and clinical use of haptic technologies in neuro-rehabilitation of the hand. AbstractPurpose. This paper provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand. Method. A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date.Results. Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation, however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. Conclusions. Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realised.

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Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke

Abstract: Cutaneous stimulation had positive effects in the motor performance, limb sensation and the configuration of SEP of the paretic limb in chronic stroke patients.

Cited by 128 publications

References 22 publications

Transcutaneous Electrical Nerve Stimulation Combined With Task-Related Training Improves Lower Limb Functions in Subjects With Chronic Stroke

Transcutaneous Electrical Nerve Stimulation Combined With Task-Related Training Improves Lower Limb Functions in Subjects With Chronic Stroke

Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders

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