Effects of Repetitive Peripheral Sensory Stimulation in the Subacute and Chronic Phases After Stroke: Study Protocol for a Pilot Randomized Trial (original) (raw)
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Neurorehabilitation and neural repair, 2018
Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance. To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke. We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed. There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% CI, 0.09-1.24; I = 65%). Only 1 study included subjects in the subacute phase after stroke. Subgroup anal...
Stroke; a journal of cerebral circulation, 2016
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). 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. 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 Te...
Trials, 2019
Background: Reduction in sensorimotor function of the upper limb is a common and persistent impairment after stroke, and less than half of stroke survivors recover even basic function of the upper limb after a year. Previous work in stroke has shown that repetitive sensory stimulation (RSS) of the upper limb may benefit motor function. As yet, there have been no investigations of RSS in the early-acute period despite this being the time window during which the neuroplastic processes underpinning sensorimotor recovery are likely to occur. Methods: A single-blinded, stratified, randomised controlled feasibility study was undertaken at two NHS acute trusts to determine the recruitment rate, intervention adherence, and safety and acceptability of an RSS intervention in the early period after stroke. Participants were recruited within 2 weeks of index stroke. Stratified on arm function, they were randomised to receive either 45 min of daily RSS and usual care or usual care alone (UC) for 2 weeks. Changes from baseline on the primary outcome of the Action Research Arm Test (ARAT) to measurements taken by a blinded assessor were examined after completion of the intervention (2 weeks) and at 3 months from randomisation. Results: Forty patients were recruited and randomised (RSS n = 23; UC n = 17) with a recruitment rate of 9.5% (40/417) of patients admitted with a stroke of which 52 (12.5%) were potentially eligible, with 10 declining to participate for various reasons. Participants found the RSS intervention acceptable and adherence was good. The intervention was safe and there were no serious adverse events. Conclusions: This study indicates that recruitment to a trial of RSS in the acute period after stroke is feasible. The intervention was well tolerated and appeared to provide additional benefit to usual care. In addition to a definitive trial of efficacy, further work is warranted to examine the effects of varying doses of RSS upon arm function and the mechanism by which RSS induces sensorimotor recovery in the acute period after stroke.
Frontiers in Human Neuroscience, 2022
Background: We investigated whether transcranial magnetic stimulation (rTMS) over the primary somatosensory cortex (S1) and sensory stimulation (SS) could promote upper limb recovery in participants with subacute stroke. Methods: Participants were randomized into four groups: rTMS/Sham SS, Sham rTMS/SS, rTMS/SS, and control group (Sham rTMS/Sham SS). Participants underwent ten sessions of sham or active rTMS over S1 (10 Hz, 1,500 pulses, 120% of resting motor threshold, 20 min), followed by sham or active SS. The SS involved active sensory training (exploring features of objects and graphesthesia, proprioception exercises), mirror therapy, and Transcutaneous electrical nerve stimulation (TENS) in the region of the median nerve in the wrist (stimulation intensity as the minimum intensity at which the participants reported paresthesia; five electrical pulses of 1 ms duration each at 10 Hz were delivered every second over 45 min). Sham stimulations occurred as follows: Sham rTMS, coil was held while disconnected from the stimulator, and rTMS noise was presented with computer loudspeakers with recorded sound from a real stimulation. The Sham SS received therapy in the unaffected upper limb, did not use the mirror and received TENS stimulation for only 60 seconds. The primary outcome was the Body Structure/Function: Fugl-Meyer Assessment (FMA) and Nottingham Sensory Assessment (NSA); the secondary outcome was the Activity/Participation domains, assessed with Box and Block Test, Motor Activity Log scale, Jebsen-Taylor Test, and Functional Independence Measure. Results: Forty participants with stroke ischemic (n = 38) and hemorrhagic (n = 2), men (n = 19) and women (n = 21), in the subacute stage (10.6 ± 6 weeks) had a mean age of 62.2 ± 9.6 years, were equally divided into four groups (10 participants in each
BMC Neurology
Background: Repetitive sensory stimulation (RSS) adapts the timing of stimulation protocols used in cellular studies to induce synaptic plasticity. In healthy subjects, RSS leads to widespread sensorimotor cortical reorganization paralleled by improved sensorimotor behavior. Here, we investigated whether RSS reduces sensorimotor upper limb impairment in patients with subacute stroke more effectively than conventional therapy. Methods: A single-blinded sham-controlled clinical trial assessed the effectiveness of RSS in treating sensorimotor deficits of the upper limbs. Patients with subacute unilateral ischemic stroke were randomly assigned to receive standard therapy in combination with RSS or with sham RSS. Patients were masked to treatment allocation. RSS consisted of intermittent 20 Hz electrical stimulation applied on the affected hand for 45 min/day, 5 days per week, for 2 weeks, and was transmitted using custom-made stimulation-gloves with built-in electrodes contacting each fingertip separately. Before and after the intervention, we assessed light-touch and tactile discrimination, proprioception, dexterity, grip force, and subtasks of the Jebsen Taylor hand-function test for the non-affected and the affected hand. Data from these quantitative tests were combined into a total performance index serving as primary outcome measure. In addition, tolerability and side effects of RSS intervention were recorded. Results: Seventy one eligible patients were enrolled and randomly assigned to receive RSS treatment (n = 35) or sham RSS (n = 36). Data of 25 patients were not completed because they were transferred to another hospital, resulting in n = 23 for each group. Before treatment, sensorimotor performance between groups was balanced (p = 0.237). After 2 weeks of the intervention, patients in the group receiving standard therapy with RSS showed significantly better restored sensorimotor function than the control group (standardized mean difference 0.57; 95% CI-0.013-1.16; p = 0.027) RSS treatment was superior in all domains tested. Repetitive sensory stimulation was well tolerated and accepted, and no adverse events were observed.
Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke
Clinical Rehabilitation, 2002
Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke. Subjects and setting: Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation. Thirty-two received active treatment in the paretic hand and eight received no-current placebo treatment in the paretic hand. Nineteen patients received active stimulation of the paretic foot. None received stimulation in both upper and lower limbs. Intervention: Cutaneous stimulation was delivered twice daily via a special glove/sock electrode. Main outcome measures: Modi ed Motor Assessment Scale, 10-metre walking test, paretic limb function, limb skin sensation and somatosensor y evoked potentials (SEP) were performed before and after the treatment. Results: Modi ed Motor Assessment Scale (p < 0.001), 10-metre walking test (p < 0.05), paretic hand function (p < 0.01), upper limb skin sensation (p < 0.01) and SEP normality classi cation of paretic upper limb (p < 0.01) and paretic lower limb (p < 0.5) improved signi cantly in the treatment group (n = 51) after three weeks of stimulation. When active hand treatment and placebo hand treatment were compared, a signi cant improvement in the sensory and motor function was observed only in the actively treated group. Conclusions: Cutaneous stimulation had positive effects in the motor performance, limb sensation and the con guration of SEP of the paretic limb in chronic stroke patients.
Neurorehabilitation and Neural Repair, 2012
Background. Proof-of-principle studies have demonstrated transient beneficial effects of transcranial direct current stimulation (tDCS) on motor function in stroke patients, mostly after single treatment sessions. Objective. To assess the efficacy of multiple treatment sessions on motor outcome. Methods. The authors examined the effects of two 5-day intervention periods of bihemispheric tDCS and simultaneous occupational/physical therapy on motor function in a group of 10 chronic stroke patients. Results. The first 5-day period yielded an increase in Upper-Extremity Fugl-Meyer (UE-FM) scores by 5.9 ± 2.4 points (16.6% ± 10.6%). The second 5-day period resulted in further meaningful, although significantly lower, gains with an additional improvement of 2.3 ± 1.4 points in UE-FM compared with the end of the first 5-day period (5.5% ± 4.2%). The overall mean change after the 2 periods was 8.2 ± 2.2 points (22.9% ± 11.4%). Conclusion. The results confirm the efficacy of bihemispheric tDCS in combination with peripheral sensorimotor stimulation. Furthermore, they demonstrate that the effects of multiple treatment sessions in chronic stroke patients may not necessarily lead to a linear response function, which is of relevance for the design of experimental neurorehabilitation trials.
https://www.ijhsr.org/IJHSR\_Vol.10\_Issue.7\_July2020/IJHSR\_Abstract.026.html, 2020
Introduction: Rehabilitation measures help to restore lost activities, improve quality of life and decrease the long term economic cost of stroke. Realistic goal setting, interdisciplinary team approach and the active participation of both patient and family members are important for the success of stroke rehabilitation. The primary objective of this study is to investigate the effects of intense sensory motor stimulation, given in the form of electrical stimulation, massage and re-education exercise programme, in augmenting recovery in stroke patients. Methods: A prospective single group pre and post test study design was conducted with a total of 29 hemiparetic patients who provided informed consent. All the participants received the therapeutic measures of electrical stimulation, massage and re-education exercises including gait training and ADL retraining until discharge. The Neurological and Functional recovery were measured using Scandinavian Stroke Scale score (SSS) and Functional Independence Measure score (FIM) respectively. Results: An Analysis of variance 'F' Value of 37.31 and 43.94 which are significant at 0.01 level shows that there is a significant difference between scores at admission, discharge and follow up in SSS and FIM scores respectively. The Pearson correlation coefficient 'r' value of 0.62, 0.81 and 0.97 at three time periods suggests that a moderate to strong negative correlation exists between SSS and FIM scores which are significant at 0.01 levels. Conclusion: A significant level of neurological and functional recovery was obtained in the study group during the time of discharge and in the follow up period indicative of effectiveness of intense sensory motor stimulation in augmenting motor recovery in stroke patients.