Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke: A Randomized Trial.

Abstract

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, 0.6-8.4; 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.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02633215.

• Authors: Cheryl Carrico, Kenneth C Chelette 2nd, Philip M Westgate, Elizabeth Powell, Laurie Nichols, Anne Fleischer, Lumy Sawaki
• Journal: Stroke (Stroke) Vol. 47 Issue 7 Pg. 1879-84 (07 2016) ISSN: 1524-4628 [Electronic] United States
• PMID: 27188405 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2016 American Heart Association, Inc.

Topics

• Action Potentials
• Adult
• Aged
• Electric Stimulation Therapy (methods)
• Female
• Humans
• Male
• Median Nerve
• Middle Aged
• Paresis (etiology, rehabilitation)
• Psychomotor Performance
• Radial Nerve
• Recovery of Function
• Stroke (complications)
• Stroke Rehabilitation (methods)