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Neuromodulation. 2018 Feb;21(2):176-183. doi: 10.1111/ner.12717. Epub 2017 Oct 25.

Combined Brain and Peripheral Nerve Stimulation in Chronic Stroke Patients With Moderate to Severe Motor Impairment.

Author information

1
Hospital das Clinicas/São Paulo University, São Paulo, Brazil.
2
Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
3
Departament of Neurosciences, Lerner Reasearch Institute, Cleveland Clinic, Cleveland, OH, USA.
4
Case Western Reserve University, Cleveland, OH, USA.
5
Departments of Physical Therapy and Occupational Therapy; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
6
Hospital Israelita Albert Einstein, São Paulo, Brazil.

Abstract

OBJECTIVES:

To evaluate effects of somatosensory stimulation in the form of repetitive peripheral nerve sensory stimulation (RPSS) in combination with transcranial direct current stimulation (tDCS), tDCS alone, RPSS alone, or sham RPSS + tDCS as add-on interventions to training of wrist extension with functional electrical stimulation (FES), in chronic stroke patients with moderate to severe upper limb impairments in a crossover design. We hypothesized that the combination of RPSS and tDCS would enhance the effects of FES on active range of movement (ROM) of the paretic wrist to a greater extent than RPSS alone, tDCS alone or sham RPSS + tDCS.

MATERIALS AND METHODS:

The primary outcome was the active ROM of extension of the paretic wrist. Secondary outcomes were ROM of wrist flexion, grasp, and pinch strength of the paretic and nonparetic upper limbs, and ROM of wrist extension of the nonparetic wrist. Outcomes were blindly evaluated before and after each intervention. Analysis of variance with repeated measures with factors "session" and "time" was performed.

RESULTS:

After screening 2499 subjects, 22 were included. Data from 20 subjects were analyzed. There were significant effects of "time" for grasp force of the paretic limb and for ROM of wrist extension of the nonparetic limb, but no effects of "session" or interaction "session x time." There were no significant effects of "session," "time," or interaction "session x time" regarding other outcomes.

CONCLUSIONS:

Single sessions of PSS + tDCS, tDCS alone, or RPSS alone did not improve training effects in chronic stroke patients with moderate to severe impairment.

KEYWORDS:

Electric stimulation therapy; motor skills; sensory function; stroke rehabilitation; transcranial direct current stimulation; transcutaneous electric nerve stimulation

PMID:
29067749
PMCID:
PMC5801160
DOI:
10.1111/ner.12717
[Indexed for MEDLINE]
Free PMC Article

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