The Effect of Combined Somatosensory Stimulation and Task-Specific Training on Upper Limb Function in Chronic Stroke

Fleming, Melanie K.; Sorinola, Isaac Olubunmi; Roberts-Lewis, Sarah F.; Wolfe, Charles D.A.; Wellwood, Ian; Newham, Di J.

doi:10.1177/1545968314533613

Cited by 50 publications

(33 citation statements)

References 29 publications

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“…The literature reports only 1 study that, similar to the present study, applied simultaneous stimulation of median, radial, and ulnar nerves 33 . (However, in delivering PNS at the elbow, this protocol differed from the present study, which delivered multiple nerve stimulation more distally.…”

Section: Discussionmentioning

confidence: 51%

“…Additionally, the present study delivered individual PNS trains with an offset of 35ms between each stimulation channel to prevent stimulation of distal nerves from being blocked by stimulation of more proximal nerves, a phenomenon known as “collision” in nerve conduction studies 34, 35 .) Fleming and colleagues administered 2 hours of PNS immediately prior to 30 minutes of task-specific training for 33 subjects with chronic stroke 33 . At post-intervention, more significant improvement on the ARAT was evident for the active PNS group compared with the sham PNS group; but no significant between-groups difference was evident on secondary measures (ie, FMA; Motor Activity Log; Goal Attainment Scale) or at long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Carrico

Chelette

Westgate

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

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Background Constraint-based therapy and peripheral nerve stimulation can significantly enhance movement function after stroke. No studies have investigated combining these interventions for cases of chronic, mild-to-moderate hemiparesis following stroke. Objective Determine the effects of peripheral nerve stimulation paired with a modified form of constraint-induced therapy on upper extremity movement function after stroke. Design Nineteen adult stroke survivors with mild-to-moderate hemiparesis more than 12 months after stroke received 2 hours of either active (n=10) or sham (n=9) peripheral nerve stimulation preceding 4 hours of modified constraint-induced therapy (10 sessions). Results Active peripheral nerve stimulation enhanced modified constraint-induced therapy more than sham peripheral nerve stimulation (significance at P<0.05), both immediately after intervention (Wolf Motor Function Test: P=0.006 (timed score); P=0.001 (lift score); Fugl-Meyer Assessment: P=0.022; Action Research Arm Test: P=0.007); and at 1-month follow-up (Wolf Motor Function Test: P=0.025 (timed score); P=0.007 (lift score); Fugl-Meyer Assessment: P=0.056; Action Research Arm Test: P=0.028). Conclusion Pairing peripheral nerve stimulation with modified constraint-induced therapy can lead to significantly more improvement in upper extremity movement function than modified constraint-induced therapy alone. Future research is recommended to help establish longitudinal effects of this paired intervention, particularly as it affects movement function and daily life participation.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Carrico

Chelette

Westgate

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Task-specific training was recently reported to induce long-term improvements (up to 6 months from the intervention) in upper limb motor function after stroke 83 . We speculate that the BCI-based rewarding 28,84 of MI promotes longlasting retention of motor performance with respect to MI practice in an open loop condition.…”

Section: Functional Outcomementioning

confidence: 99%

Brain–computer interface boosts motor imagery practice during stroke recovery

Pichiorri

Morone

Petti

et al. 2015

Annals of Neurology

522

472

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Section: July 2016mentioning

confidence: 99%

“…7 In addition, randomized controlled trials showing that PNS can enhance outcomes of task-oriented training have primarily targeted only mild-to-moderate UE impairment. [16][17][18][19] In sum, although pairing PNS with motor training can enhance motor recovery after stroke, it remains unclear how severity of motor deficit may affect responsiveness to this paired intervention.14 To address these evidence gaps, the purpose of this study was to investigate whether active PNS paired with intensive task-oriented training would lead to significantly more improved movement function than sham PNS paired with intensive task-oriented training for subjects with chronic, severe deficit in UE movement function after stroke. …”

mentioning

confidence: 99%

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke

Carrico

Chelette

Westgate

et al. 2016

Stroke

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Background and Purpose-A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement). Methods-Subjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up. Results-Statistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, −0.21 to −0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on ≥1 outcomes at ≥1 time points after intervention. Conclusions-After stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed. Corroborating evidence from a systematic review of randomized and quasi-randomized trials indicated that motor recovery after stroke may be enhanced with PNS, especially when PNS is delivered as an adjunct to motor training. 13,14A well-validated form of motor training called intensive task-oriented training has been associated with significant neuroplastic change, as well as more significant functional gains than usual and customary care, in cases of mild-to-moderate hemiparesis. 15 Further research is needed to optimize intensive task-oriented training for people with severely impaired movement function after stroke. 7 In addition, randomized controlled trials showing that PNS can enhance outcomes of task-oriented training have primarily targeted only mild-to-moderate UE impairment. [16][17][18][19] In sum, although pairing PNS with motor training can enhance motor recovery after stroke, it remains unclear how severity of motor deficit may affect responsiveness to this paired intervention.14 To address these evidence gaps, the purpose of this study was to investigate whether active PNS paired with intensive task-oriented training would lead to significantly more improved movement function than sham PNS paired with intensive ta...

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The Effect of Combined Somatosensory Stimulation and Task-Specific Training on Upper Limb Function in Chronic Stroke

Abstract: Long-lasting improvements in upper limb function were observed following TST. Additional benefit of SS was seen immediately post treatment, but did not persist and the underlying mechanisms remain unclear.

Cited by 50 publications

References 29 publications

Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Brain–computer interface boosts motor imagery practice during stroke recovery

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke

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