Journal
NEUROREHABILITATION AND NEURAL REPAIR
Volume 29, Issue 2, Pages 143-152Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1545968314533613
Keywords
stroke; electrical stimulation; upper extremity; task-specific training; rehabilitation; neurophysiology
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Funding
- Dunhill Medical Trust [R102/0209]
- South London Clinical Local Research Network
- Department of Health through the National Institute for Health Research (NIHR) Biomedical Research Centre
- King's College London
- King's College Hospital NHS Foundation Trust
- National Institute for Health Research [NF-SI-0510-10060, RP-PG-0407-10184] Funding Source: researchfish
- The Dunhill Medical Trust [R102/0209] Funding Source: researchfish
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Background. Somatosensory stimulation (SS) is a potential adjuvant to stroke rehabilitation, but the effect on function needs further investigation. Objective. To explore the effect of combining SS with task-specific training (TST) on upper limb function and arm use in chronic stroke survivors and determine underlying mechanisms. Methods. In this double-blinded randomized controlled trial (ISRCTN 05542931), 33 patients (mean 37.7 months poststroke) were block randomized to 2 groups: active or sham SS. They received 12 sessions of 2 hours of SS (active or sham) to all 3 upper limb nerves immediately before 30 minutes of TST. The primary outcome was the Action Research Arm Test (ARAT) score. Secondary outcomes were time to perform the ARAT, Fugl-Meyer Assessment score (FM), Motor Activity Log (MAL), and Goal Attainment Scale (GAS). Underlying mechanisms were explored using transcranial magnetic stimulation stimulus-response curves and intracortical inhibition. Outcomes were assessed at baseline, immediately following the intervention (mean 2 days), and 3 and 6 months (mean 96 and 190 days) after the intervention. Results. The active group (n = 16) demonstrated greater improvement in ARAT score and time immediately postintervention (between-group difference; P < .05), but not at 3- or 6-month follow-ups (P > .2). Within-group improvements were seen for both groups for ARAT and GAS, but for the active group only for FM and MAL (P < .05). Corticospinal excitability did not change. Conclusions. 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.
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