A randomized controlled trial of Cognitive Sensory Motor Training Therapy on the recovery of arm function in acute stroke patients Adding transcutaneous electrical nerve stimulation to visual scanning training does not enhance treatment effect on hemispatial neglect: a randomized, controlled, double-blind study Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: A randomized controlled study. Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke: A Randomized Trial Change in Functional Arm Use Is Associated With Somatosensory Skills After Sensory Retraining Poststroke Increased Pinch Strength in Acute and Subacute Stroke Patients After Simultaneous Median and Ulnar Sensory Stimulation Immediate effects of somatosensory stimulation on hand function in patients with poststroke hemiparesis: a randomized cross-over trial The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke: a randomized controlled cross-over trial Treating sensory impairments in the post-stroke upper limb with intermittent pneumatic compression. Results of a preliminary trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study. The Combined Impact of Virtual Reality Neurorehabilitation and Its Interfaces on Upper Extremity Functional Recovery in Patients With Chronic Stroke Home-Based Nerve Stimulation to Enhance Effects of Motor Training in Patients in the Chronic Phase After Stroke Facilitation of Sensory and Motor Recovery by Thermal Intervention for the Hemiplegic Upper Limb in Acute Stroke Patients: A Single-Blind Randomized Clinical Trial Left-hand somatosensory stimulation combined with visual scanning training in rehabilitation for post-stroke hemineglect: A randomised, double-blind study Effect of Thermal Stimulation on Upper Extremity Motor Recovery 3 Months After Stroke Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. Segmental Muscle Vibration Improves Walking in Chronic Stroke Patients With Foot Drop: A Randomized Controlled Trial Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes Rehabilitation of Reaching Poststroke: A Randomized Pilot Investigation of Tactile Versus Auditory Feedback for Trunk Control Combining Afferent Stimulation and Mirror Therapy for Rehabilitating Motor Function, Motor Control, Ambulation, and Daily Functions After Stroke Effectiveness of thermal stimulation for the moderately to severely paretic leg after stroke: serial changes at one-year follow-up. Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Effect of a local vibration stimulus training programme on postural sway and gait in chronic stroke patients: a randomized controlled trial Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke The Effect of Combined Somatosensory Stimulation and Task-Specific Training on Upper Limb Function in Chronic Stroke Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke. Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial Increase in hand muscle strength of stroke patients after somatosensory stimulation Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. Stochastic Resonance Stimulation for Upper Limb Rehabilitation Poststroke Facilitation of motor and balance recovery by thermal intervention for the paretic lower limb of acute stroke: a single-blind randomized clinical trial Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke: a pilot randomized crossover trial Effects of Somatosensory Stimulation on Motor Function After Subacute Stroke
Objective : The aim of this study was to evaluate the effectiveness of Cognitive Sensory Motor Training Therapy ( Perfetti ’s method ) vis-à-vis conventional occupational therapy in the recovery of arm function after acute stroke . Design : Prospect i ve r and omized controlled trial . Setting : Two rehabilitation centers in Bangkok , Thail and . Subjects : Forty first-time acute stroke patients without severe cognitive or language impairment . Intervention : All subjects were r and omly divided into two groups ; one was treated using Perfetti ’s method and the other using conventional occupational therapy . Each group underwent therapy for 30 minutes , five times a week for four weeks . Main measures : The primary variable was arm function as assessed by the Action Research Arm Test ; secondary variables were the extended Barthel Index and the box and block test score . Results : The intention-to-treat analysis revealed no statistically significant differences between the two groups at the end of treatment for any variable . Conclusions : There was no evidence of a difference between Cognitive Sensory Motor Training Therapy of Perfetti ’s method and conventional occupational therapy with respect to the restoration of h and and arm function after a stroke Background : Left-sided transcutaneous electrical nerve stimulation ( TENS ) increases right hemispheric activity , which may improve the rehabilitative outcome of hemispatial neglect . Objective : To examine the behavioral effect of electrical stimulation of the nerve afferents of the left h and during early neuropsychological rehabilitation of post-stroke patients with hemispatial neglect . Methods : This r and omized , controlled , double-blind study included 29 patients ( enrolled in the experimental or control group ) with left hemispatial neglect after right hemispheric stroke . For 3 weeks , patients received 15 therapeutic sessions involving TENS ( active or sham ) with a mesh glove applied on the entire left h and during the first 30 minutes of a 45-minute conventional visual scanning training ( VST ) .  Signs of hemispatial neglect were assessed using a psychometric test before and after treatment . Results : Univariate analysis of covariance revealed that differences between the control and experimental groups were not significant after treatment ( F(1 , 22 ) = 0.294 , P = 0.593 ) when adjusted for pre-treatment scores and time since stroke onset . This suggested that electrical stimulation failed to mitigate the severity of hemispatial neglect symptoms . Conclusion : Our study did not provide evidence of the effectiveness of  TENS when added to VST during early rehabilitation for patients with post-stroke hemispatial neglect . Other techniques ( applied alone or together ) should be sought to improve recovery in this population Sit-to-st and is a fundamental movement of human being for performing mobility and independent activity . However , Stroke people symptoms experience difficulty in conducting the sit-to-st and due to paralysis and especially ankle spasticity . Recently , transcutaneouselectrical- stimulation ( TENS ) is used to reduce pain but also to manage spasticity . The purpose of this study was to determine ( 1 ) whether TENS would lead to ankle spasticity reduction and ( 2 ) whether sit-to-st and training combined with TENS would improve spasticity , muscle strength and balance ability in stroke patients . Forty-stroke patients were recruited and were r and omly divided into two groups : TENS group ( n=20 ) and sham group ( n=20 ) . All participants underwent 30-sessions of sit-to-st and training ( for 15-min , five-times per week for 6-weeks ) . Prior to each training session , 30-min of TENS over the peroneal nerve was given in TENS group , whereas sham group received non-electrically stimulated TENS for the same amount of time . Composite-Spasticity-Score was used to assess spasticity level of ankle plantar-flexors . Isometric strength in the extensor of hip , knee and ankle were measured by h and held dynamometer . Postural-sway distance was measured using a force platform . The spasticity score in the TENS group ( 2.6±0.8 ) improved significantly greater than the sham group ( 0.7±0.8 , p<0.05 ) . The muscle strength of hip extensor in the TENS group ( 2.7±1.1 kg ) was significantly higher than the sham group ( 1.0±0.8 kg , p<0.05 ) . Significant improvement in postural-sway was observed in the TENS group compared to the sham group ( p<0.05 ) . Thus , sit-to-st and training combined with TENS may be used to improve the spasticity , balance function and muscle strength in stroke patients 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 r and omized 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 clinical ly 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 . clinical trials.gov . Unique identifier : NCT02633215 OBJECTIVE . We investigated changes in functional arm use after retraining for stroke-related somatosensory loss and identified whether such changes are associated with somatosensory discrimination skills . METHOD . Data were pooled ( N = 80 ) from two r and omized controlled trials of somatosensory retraining . We used the Motor Activity Log to measure perceived amount of arm use in daily activities and the Action Research Arm Test to measure performance capacity . Somatosensory discrimination skills were measured using st and ardized modality-specific measures . RESULTS . Participants ’ arm use improved after somatosensory retraining ( z = −6.80 , p < .01 ) . Change in arm use was weakly associated with somatosensation ( tactile , & bgr ; = 0.31 , p < .01 ; proprioception , & bgr ; = −0.17 , p > .05 ; object recognition , & bgr ; = 0.13 , p < .05 ) . CONCLUSION . Change in daily arm use was related to a small amount of variance in somatosensory outcomes . Stroke survivors  ’ functional arm use can increase after somatosensory retraining , with change varying among survivors Background . Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation . Objective . Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke . Methods . Stroke patients ( N = 20 ) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a r and omized , single-blinded , controlled study . Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias ( peripheral sensory stimulation group ) . Ten control patients received stimulation to the level of perception ( sham-control group ) . Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic h and and the Action Research Arm test were tested before and immediately after the stimulation . Results . Lateral and tip pinch strength were significantly increased in both groups ( P < .05 ) . Mean ± SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 ± 0.54 pounds and 0.20 ± 0.28 pounds , respectively . Mean ± SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 ± 0.72 pounds and 0.37 ± 0.36 pounds , respectively . Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group , with significant difference ( P < .05 ) . The Action Research Arm test was not significantly changed after stimulation in both groups ( P > .05 ) . Conclusion . Peripheral sensory stimulation of the paretic h and may increase pinch strength of acute and subacute stroke patients immediately after stimulation This study aim ed to determine the immediate effects of somatosensory stimulation on h and function in patients with poststroke hemiparesis . Eleven patients with poststroke hemiparesis participated in this study . Four types ( no stimulation , vibration , and light and rough touches ) of somatosensory stimulation were performed r and omly for 4 days applying only one type of somatosensory stimulation each day . The box and block test ( BBT ) , the Jebsen – Taylor h and function test ( JTHFT ) , h and grip strength ( HGS ) , and movement distance and peak velocity of the wrist joint during a forward-reaching task were measured . The BBT and JTHFT scores for no stimulation [ BBT : median ( interquartile range ) , 0.00 ( −1.00 to 1.00 ) and JTHFT : 2.57 ( −0.47 to 4.92 ) ] were significantly different from those for vibration [ BBT : 3.00 ( 2.00–5.00 ) and JTHFT : −16.02 ( −23.06 to −4.31 ) ] , light touch [ BBT : 3.00 ( 1.00–4.00 ) and JTHFT : −5.00 ( −21.20 to −0.94 ) ] , and rough touch [ BBT : 2.00 ( 1.00–4.00 ) and JTHFT : −6.19 ( −18.22 to −3.70 ) ] . The JTHFT score was significantly higher for vibration than that for rough touch ( P<0.05 ) . The increase in HGS was significantly greater for light touch than that for no stimulation ( P<0.05 ) and for vibration than that for light touch ( P<0.05 ) . There were significant differences for the sagittal and coronal planes in movement distance and for the sagittal and horizontal planes in peak velocity during the forward-reaching task ( P<0.05 ) . The findings suggest that somatosensory stimulation may be advantageous to improve the h and function of patients with poststroke hemiparesis , with more favorable effects observed in vibration stimulation Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported Objective : To evaluate the efficacy of intermittent pneumatic compression ( IPC ) in treating  sensory impairments in the hemiplegic upper limb in stroke patients . Design : Twenty-three stroke patients were enrolled in a r and omized , controlled preliminary trial that compared the application of intermittent pneumatic compression with a passive treatment strategy . Setting : Four Belgian day centers for treatment of neurological disabilities . Four acute and rehabilitation care wards specialized in neurological treatment . Subjects : Twenty-three stroke patients . Interventions : The experimental group ( n = 11 ) received st and ard physiotherapy combined with intermittent pneumatic compression treatment ( 10 cycles of 3 minutes with a peak of 40 mmHg ) for their hemiplegic upper limb . The control group ( n = 12 ) received supplementary to their conventional physiotherapy a placebo treatment , namely sham short-wave therapy on the hemiplegic shoulder for 30 minutes . Main outcome measures : Sensory impairments were clinical ly assessed at three occasions over a period of four weeks using the Nottingham Sensory Assessment scale . Results : Both groups improved in somatosensation over time , but the experimental group improved more than the control group ( p = 0.036 ) or 81.1 % improvement versus 30.9 % . Conclusions : The use of intermittent pneumatic compression in the rehabilitation of stroke patients may be of clinical importance for the restoration of sensory function Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND / PURPOSE Mirror therapy ( MT ) has been recommended as a simple , inexpensive approach to treat motor dysfunction . The use of a mesh glove ( MG ) was suggested to normalize muscle tone that ameliorates motor impairment . Combining two efficient treatment protocol s might maximize the benefits from training . This study investigated the effects of MT combined with MG ( MG + MT ) versus MT alone on motor performance and daily function after stroke . METHODS Sixteen patients with chronic unilateral stroke were recruited . A r and omized two-group pretest and posttest design was used to r and omly assign participants to MG + MT or MT groups . MT involves repetitive bimanual , symmetrical movement practice in which the individual moves the affected limb as much as she/he could while watching the reflective illusion of the unaffected limb 's movements from a mirror . The MG + MT group wore a MG on the affected h and during the MT . The Modified Ashworth scale of muscle spasticity ( MAS ) , Action Research Arm Test ( ARAT ) , Box and Block Test ( BBT ) , and Functional Independence Measure ( FIM ) were administered to evaluate spasticity , and motor and daily function . RESULTS The results for the BBT ( p = 0.013 ) , total scores ( p = 0.031 ) , grasping subscales ( p = 0.036 ) of ARAT , and FIM transfer scores ( p = 0.013 ) presented significantly large effects in favor of the MG + MT group . CONCLUSION Combining MG with MT significantly improves manual dexterity , grasping , and transfer performance . Adding the MG component into the MT likely increased the richness of sensory input and improved the movement performance more than MT alone Background and Purpose — Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation , it is not yet well understood how the different aspects of these systems affect recovery . Consequently , we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects . Methods — To specifically address this issue , we developed 3 different configurations of the same VR-based rehabilitation system , the Rehabilitation Gaming System , using 3 different interface technologies : vision-based tracking , haptics , and a passive exoskeleton .  Forty-four patients with chronic stroke were r and omly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks . Results — Our results revealed significant within-subject improvements at most of the st and ard clinical evaluation scales for all groups . Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user , that is , visual feedback versus combined visual haptic feedback . Conclusions — Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used . These results have strong implication s for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention . Clinical Trial Registration — This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks . All the patients were able to perform tasks of the Jebsen – Taylor Test ( JTT ) . The primary outcome measures were feasibility , evaluated by self-reported compliance with the intervention , and safety ( adverse events ) . Secondary outcomes comprised improvements in h and function in the JTT after end of treatment and after a 4-month follow-up period . Results . There were no relevant adverse events . Compliance with RPSS and motor training was significantly greater in the active group than in the sham group . Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment . This difference remained significant 4 months later , even when differences in compliance with motor training were considered . Conclusions . Home-based active RPSS associated with motor training was feasible , was safe , and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT . These results point to the need for an efficacy trial Background and Purpose — Thermal stimulation ( TS ) is commonly used in orthopedic rehabilitation , but the role of TS in the facilitation of sensorimotor recovery in hemiplegic patients remains unknown . This study addressed the issue of TS intervention in the facilitation of functional outcomes . Methods — Forty-six stroke survivors were r and omly assigned to st and ard rehabilitation treatment and st and ard treatment plus TS ( 30 minutes daily for 6 weeks ) . Twenty-nine patients completed the experiment . Six measures , including Brunnstrom stage , modified motor assessment scale , grasping strength , angles of wrist extension and flexion , sensation by monofilament , and muscle tone by modified Ashworth scale , were performed weekly to evaluate sensory and motor functional outcomes . Results — The performance of Brunnstrom stage and wrist extension and sensation were improved significantly after TS intervention . Recovery rates of 6 measures after TS were significantly higher than those of the control , except for grasping . Similar muscle tones were found in both groups . Conclusion — TS on the paretic h and significantly enhances the recovery of several aspects of sensory and motor functions in hemiplegic stroke patients The aim of this r and omised , double-blind study was to investigate the therapeutic effectiveness of left-h and electrical stimulation for patients with post-stroke left visuo-spatial neglect . This approach was hypothesised to enhance activation of the right hemisphere attention system and to improve visual exploration of extrapersonal space .  Participants ( n = 40 ) in the study were in a relatively early stage of recovery from their first right hemisphere stroke , and were r and omly assigned to the experimental ( E ) or control ( C ) group . Group E received conventional visual scanning training combined with electrostimulation of the left h and , while Group C received scanning training with sham stimulation . Their visuo-spatial neglect was assessed twice , prior to the rehabilitation programme and on its completion , using cancellation tests and a letter-reading task . The effect of electrostimulation on hemineglect was assessed following a single administration and after a month-long rehabilitation programme . Although the immediate effect of stimulation was poor , after a month-long rehabilitation period we found significantly greater improvement in Group E patients than in Group C patients . Interestingly , the presence of hemisensory loss did not weaken the observed effect . Therefore , we cl aim that contralesional h and stimulation combined with visual scanning was a more effective treatment for hemineglect rehabilitation than scanning training alone Background and Purpose — To examine the effect of thermal stimulation ( TS ) on upper extremity ( UE ) motor recovery in patients at least 3 months after stroke . Methods — Participants were r and omly assigned to either the experimental group or the control group . In addition to regular rehabilitation programs , the experimental group received an UE-TS protocol for 30 minutes per day ( 3 days/week for 8 weeks ) ; the control group received the same TS protocol on lower extremity . The UE subscale of the Stroke Rehabilitation Assessment of Movement and the Action Research Arm Test were primary outcome measures . The Modified Ashworth Scale and the Barthel Index were secondary outcome measures . All measures were administered at baseline , after TS , and at 1-month follow-up . Results — Twenty-three participants ( 12 in the experimental group ) completed the study . After treatment , the experimental group showed significant improvement compared to the control group in the scores of the UE subscale of the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test . At follow-up examination , a significant improvement in the experimental group was observed on the UE subscale of the Stroke Rehabilitation Assessment of Movement . Conclusions — The 8-week additional UE-TS protocol improved UE motor recovery for stroke patients 3 months after onset Background : Sensory amplitude electrical stimulation ( SES ) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke . Objective : To determine if home-based , task-specific arm exercise was more effective when administered concurrent with SES . Methods : Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment ( FMA ) score 28/66 ( 15–45 ) participated . Subjects were r and omly assigned to an SES ( n = 20 ) or sham stimulation ( n = 18 ) group . Subjects engaged in task-based home exercise for 30 minutes , twice daily , for four weeks while wearing a glove electrode on the impaired h and . Experimental subjects received SES while control subjects received sham stimulation during exercise . Primary outcome measures : FMA and Arm Motor Ability Test ( AMAT ) . Results : There were no significant between-group differences for outcome measures . There was a significant difference between the pre- and post-test scores in the SES group AMAT median time ( P = 0.003 95 % confidence interval ( CI ) : −14.304 , −6.365 ; effect size : 0.84 ) . Practice time was not associated with changes in outcomes . Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time ( P = 0.037 ) . There was a significant relationship between baseline FMA score and FMA change score ( r = 0.402 ; P = 0.006 ) . Conclusions : This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors .  Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation , however there was a trend for greater improvement in one activity measure OBJECTIVE To test the hypothesis that somatosensory stimulation would enhance the effects of training functional h and tasks immediately after practice and 1 day later in chronic subcortical stroke patients . DESIGN Single-blinded and r and omized , crossover study . SETTING Human research laboratory . PARTICIPANTS Nine chronic subcortical stroke patients . INTERVENTIONS Three separate sessions of motor training preceded by ( 1 ) synchronous peripheral nerve stimulation ( PNS ) , ( 2 ) no stimulation , or ( 3 ) asynchronous PNS . MAIN OUTCOME MEASURES Time to complete the Jebsen-Taylor H and Function Test ( JTHFT time ) and corticomotor excitability tested with transcranial magnetic stimulation . RESULTS After familiarization practice , during which all patients reached a performance plateau , training under the effects of PNS reduced JTHFT time by 10 % beyond the post-familiarization plateau . This behavioral gain was accompanied by a specific reduction in GABAergically mediated intracortical inhibition in the motor cortex . These findings were not observed after similar practice under the influence of no stimulation or asynchronous PNS sessions . CONCLUSIONS Somatosensory stimulation may enhance the training of functional h and tasks in patients with chronic stroke , possibly through modulation of intracortical GABAergic pathways Background . Studies have described the effects of segmental muscle vibration ( SMV ) on brain plasticity and corticomotor excitability . Information on the treatment-induced effects of SMV in stroke patients is , however , still limited . Objectives . To assess whether the application of SMV to ankle dorsiflexor muscles of chronic stroke patients can improve walking . Methods . Forty-four patients were r and omly assigned to either an experimental group ( EG ) or a control group ( CG ) and underwent 12 sessions over 4 weeks of general physical therapy . Patients in the EG also received SMV at 120 Hz over the peroneus longus and tibialis anterior for 30 minutes at the end of each session . All the participants underwent pretreatment and posttreatment  gait analysis assessment s. Time — distance , kinematic , and surface electromyography ( EMG ) data were used as outcome measures . Results . A moderate improvement in mean gait speed , normal-side swing velocity , bilateral stride length , and normal-side toe-off percentage was observed only in the EG . A significant increase in bilateral ankle dorsiflexion angle at heel contact was associated with increased maximum ankle dorsiflexion and plantarflexion degrees during the swing phase on the paretic side after treatment in EG . Surface EMG during the swing phase revealed a significant increase in the activation of the tibialis anterior muscle on the paretic side in the posttreatment assessment in the EG . Conclusions . SMV added to general physical therapy may improve gait performance in patients with foot drop secondary to chronic stroke . The authors hypothesize that this may be due to the mechanical vibration stimulation , probably as a consequence of effective brain reorganization Somatosensory stimulation enhances aspects of motor function in patients with chronic , predominantly subcortical infa rcts . We investigated the effects of somatosensory stimulation on motor function in stroke patients with predominantly cortical involvement in the middle cerebral artery territory in a double-blind , pseudor and omized crossover trial . Motor performance was evaluated with the Jebsen-Taylor test before , after 2-hour somatosensory stimulation , and after subsequent motor training ( n = 11 ) . In one experimental session , patients were su bmi tted to median nerve stimulation ( MNS ) and in the other session , to control stimulation ( CS ) . The order of the sessions was counterbalanced across patients . Improvement in performance in the Jebsen-Taylor test after somatosensory stimulation and after motor training was significantly greater in the MNS session than in the CS session . Additionally , patients who received MNS in the second session maintained the beneficial effects of training 30 days later . A single MNS session improves h and motor function in patients with chronic cortico-subcortical strokes and appears to favor consolidation of training effects .  Somatosensory stimulation may be an adjuvant tool for stroke rehabilitation in patients with cortical lesions Background and Purpose : For individuals poststroke , reaching with the paretic limb is often associated with compensatory trunk movement due to limited active arm movement . We conducted a pilot feasibility study to compare the effects of task-related training on reaching with the paretic limb using each of 2 different techniques for providing feedback about trunk position . We hypothesized that the use of an auditory feedback signal in response to pressure ( Sensor group ) would be more effective than feedback arising from an external device used to restrain the trunk ( Stabilizer group ) . Methods : Sixteen individuals with chronic stroke were enrolled . Participants had scores of 20 to 44 on the Upper-Arm subsection of the Fugl-Meyer Scale and demonstrated some trunk movement during the pretest assessment of the Reaching Performance Scale ( RPS ) . Participants were r and omly assigned to either the Sensor or the Stabilizer group . Both groups participated in 12 structured rehabilitation sessions with equal time duration , number of repetitions , and task-related training activities . Feedback was systematic ally and equally faded for all training . Clinical outcome measures were assessed prior to and following training . Results : Both forms of feedback were associated with changes in active shoulder motion , Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Scale and RPS ( near and far ) as determined by a 2 × 2 ( Group × Time ) analysis of variance . An interaction of RPS-near revealed that the Sensor group improved more than the Stabilizer group for this measure . However , sample size may not have been sufficient to identify differences in other measures . Discussion : Although both forms of feedback led to improvements in the majority of outcome measures , the auditory feedback signal was associated with greater improvement in RPS-near scores . Conclusion : In the rehabilitation of reaching function in individuals with stroke , the use of an auditory signaling device appears to be a feasible alternative to imposed trunk stabilization . Additional studies with larger sample sizes are needed to determine whether one approach is superior to the other Background . Mirror therapy ( MT ) and mesh glove ( MG ) afferent stimulation may be effective in reducing motor impairment after stroke . A hybrid intervention of MT combined with MG ( MT + MG ) may broaden aspects of treatment benefits . Objective . To demonstrate the comparative effects of MG + MT , MT , and a control treatment ( CT ) on the outcomes of motor impairments , manual dexterity , ambulation function , motor control , and daily function . Methods . Forty-three chronic stroke patients with mild to moderate upper extremity impairment were r and omly assigned to receive MT + MG , MT , or CT for 1.5 hours/day , 5 days/week for 4 weeks . Outcome measures were the Fugl-Meyer Assessment ( FMA ) and muscle tone measured by Myoton-3 for motor impairment and the Box and Block Test ( BBT ) and 10-Meter Walk Test ( 10 MWT ) for motor function . Secondary outcomes included kinematic parameters for motor control and the Motor Activity Log and ABILH AND Question naire for daily function . Results . FMA total scores were significantly higher and synergistic shoulder abduction during reach was less in the MT + MG and MT groups compared with the CT group . Performance on the BBT and the 10 MWT ( velocity and stride length in self-paced task and velocity in as-quickly-as-possible task ) were improved after MT + MG compared with MT . Conclusions . MT + MG improved manual dexterity and ambulation .  MT + MG and MT reduced motor impairment and synergistic shoulder abduction more than CT . Future studies may integrate functional task practice into treatments to enhance functional outcomes in patients with various levels of motor severity . The long-term effects of MG + MT remain to be evaluated UNLABELLED Liang C-C , Hsieh T-C , Lin C-H , Wei Y-C , Hsiao J , Chen J-C. Effectiveness of thermal stimulation for the moderately to severely paretic leg after stroke : serial changes at one-year follow-up . OBJECTIVE To evaluate the serial changes of long-term effects of thermal stimulation ( TS ) on acute stroke patients . DESIGN A prospect i ve study with follow-up at 3 , 6 , and 12 months after TS to assess motor and balance function of the paretic leg of acute stroke patients . SETTING A general hospital rehabilitation department . PARTICIPANTS Poststroke patients ( N=30 ) with moderate to severe impairment of leg function . INTERVENTIONS In addition to receiving st and ard rehabilitation , eligible patients were r and omly assigned to a TS group ( 5 thermal stimulations per week for 6wk ) or a control group ( 3 consultations per week for 6wk ) . MAIN OUTCOME MEASURES Fugl-Meyer lower extremity score , Medical Research Council Scale for the Lower Extremity , Berg Balance Scale , Modified Motor Assessment Scale , Functional Ambulation Classification , and Barthel Index were administered at baseline , after 4 and 6 weeks of treatment , and at the 3- , 6- , and 12-month follow-up . RESULTS No significant differences were found between the 2 groups at baseline . After TS , the Fugl-Meyer lower extremity score , Medical Research Council Scale for the Lower Extremity , Modified Motor Assessment Scale , and Functional Ambulation Classification were significantly better in the TS group , and the effects persisted for 3 months ( P<.05 ) . Significant differences were found between the 2 groups for the Berg Balance Scale and Barthel Index only at the 3-month follow-up ( P<.05 ) . However , all the effects except for the Fugl-Meyer lower extremity score had disappeared at the 6-month follow-up ( P>.05 ) . CONCLUSIONS The long-term benefits of TS for patients with acute stroke may be sustained for 3 months but disappear by the 6-month and 1-year follow-up OBJECTIVE To evaluate the effects of sensory-amplitude electric stimulation ( SES ) of the paretic leg on motor recovery and gait kinematics of patients with stroke . DESIGN R and omized , controlled , double-blind study . SETTING Rehabilitation ward and gait laboratory of a university hospital . PARTICIPANTS A total of 30 consecutive in patients with stroke ( mean age , 63.2 y ) , all within 6 months poststroke and without volitional ankle dorsiflexion were studied . INTERVENTION Both the SES group ( n=15 ) and the placebo group ( n=15 ) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks . The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks . MAIN OUTCOME MEASURES Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait . RESULTS Brunnstrom stages improved significantly in both groups ( P<.05 ) . In total , 58 % of the SES group and 56 % of the placebo group gained voluntary ankle dorsiflexion . The between-group difference of percentage change was not significant ( P>.05 ) . Gait kinematics was improved in both groups , but the between-group difference was not significant . CONCLUSIONS In our patients with stroke , SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics Objective : To investigate the effect of a local vibration stimulus training programme on postural sway and gait in stroke patients . Design : A r and omized controlled trial with two groups : a local vibration stimulus training programme group and a sham group . Setting : Inpatient rehabilitation centre . Subjects : Thirty-one chronic stroke patients . Interventions : Both groups underwent a st and ard rehabilitation programme . The local vibration stimulus training programme group ( n = 16 ) participated in the local vibration stimulus training programme for 30 minutes a day , five times a week , for six weeks . The sham group ( n = 15 ) participated in a sham local vibration stimulus training programme for 30 minutes a day , five times a week , for six weeks . Main measures : A forceplate was used to measure postural sway under two conditions : st and ing with eyes open and eyes closed . Gait ability was measured using the GAITRite system . Results : In postural sway , greater improvements in the postural sway distance with eyes-open ( –11.91 vs. 0.80 ) and eyes-closed ( –20.67 vs. –0.34 ) conditions and postural sway velocity with eyes-open ( –0.40 vs. 0.03 ) and eyes-closed ( –0.69 vs. –0.01 ) conditions were observed in the local vibration stimulus training programme group , compared with the sham group ( P < 0.05 ) . In gait ability , greater improvement in gait speed ( 15.06 vs. 2.85 ) , cadence ( 8.46 vs. 1.55 ) , step length ( 7.90 vs. 3.64 ) , and single limb support time ( 0.12 vs. 0.01 ) were observed in the local vibration stimulus training programme group , compared with the sham group ( P < 0.05 ) . Conclusions : These findings suggest that local vibration stimulus training programme is an effective method for improvement of the postural sway and gait ability of chronic stroke patients OBJECTIVE To test the influence of electric somatosensory stimulation on performance of the Jebsen-Taylor H and Function Test ( JTHFT ) , a widely used assessment of functional h and motor skills , by the paretic arm in patients with chronic stroke . DESIGN Initially , patients trained for several sessions until reaching plateau performance on the JTHFT . Subsequently , they entered a crossover r and omized study , design ed to evaluate the influence of somatosensory stimulation on JTHFT performance . SETTING A research laboratory . PARTICIPANTS Nine patients with chronic stroke ( > /=1.5 y ) who acutely had marked weakness ( paralysis of the upper extremity is evaluated as equal or below Medical Research Council [ MRC ] grade 2 ) followed by improvement to an MRC grade of 4.24+/-0.43 ( range , 3.5 - 4.9 ) and Fugl-Meyer Assessment ( FMA ) score of 86.43%+/-2.02 % at the time of testing . INTERVENTIONS Two hours of electric somatosensory stimulation was applied to the ( 1 ) paretic h and , ( 2 ) paretic leg , or ( 3 ) no stimulation in different sessions , in a r and omized order . MAIN OUTCOME MEASURE The time required to complete the JTHFT was analyzed by using repeated- measures analysis of variance ( ANOVA ) with factors time ( pre- , postintervention ) and intervention ( paretic h and , paretic leg , no stimulation ) followed by post hoc testing . RESULTS Significant effects of intervention and intervention by time interaction ( P<.01 ) on JTHFT time was revealed by repeated- measures ANOVA . Post hoc testing documented improvements in JTHFT time with paretic h and stimulation alone ( P<.005 ) , an effect that appeared more prominent in subjects with lower FMA scores . CONCLUSIONS Somatosensory stimulation applied to a paretic limb can benefit performance of a functional test in patients with chronic stroke . This result supports the proposal that electric sensory stimulation in combination with training protocol s may enhance the benefit of customary neurorehabilitative treatments and possibly motor learning Based on the principles of neuroplasticity , the purpose of this crossover study was to determine if improvement in upper extremity ( UE ) function and independence could be achieved in patients 6 months to 7 years poststroke following an outpatient rehabilitation program ( supervised 1.5 hours per week for 8 weeks reinforced with home gloving unaffected side and attended , grade d , repetitive sensory and motor training activities ) . Twenty-one subjects ( right or left hemiparesis ; able to walk 100 feet with or without a cane ; partially opened and closed the h and ; partially elevated the shoulder and elbow against gravity ) were r and omly assigned to Group A ( sensory training 4 weeks , motor training 4 weeks ) or Group B ( motor training 4 weeks , sensory training 4 weeks ) . Greater than 20 % ( P < 0.01 ) improvement was measured in functional independence and UE function ( fine motor , sensory discrimination , and musculoskeletal performance ) . Gains were hemispheric and training specific and maintained over 3 months . This study provides evidence documenting significant improvement in function in the late poststroke recovery period following 12 hours of supervised learning based sensory motor training 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 r and omized controlled trial ( IS RCT N 05542931 ) , 33 patients ( mean 37.7 months poststroke ) were block r and omized 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 OBJECTIVE To examine the effects of thermal stimulation ( TS ) on the lower extremity ( LE ) movement and function in patients with stroke . DESIGN A double-blinded r and omized controlled trial . SETTING A university hospital . PARTICIPANTS Patients ( N=34 ) at least 3 months after stroke were r and omly assigned into the experimental and the control groups . INTERVENTIONS In addition to regular rehabilitation , the experimental group received a 30-minute noxious TS protocol ( heat pain 46 - 47 ° C/cold pain 2 - 3 ° C ) 3days/wk for 8 weeks , and the control group received a 30-minute innocuous TS protocol ( heat 40 - 41 ° C/cold 23 - 24 ° C ) 3d/wk for 8 weeks . MAIN OUTCOME MEASURES The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement ( LE-STREAM ) , the Mobility subscale of STREAM ( Mob-STREAM ) , the Functional Ambulation Category ( FAC ) , the Barthel Index ( BI ) , the Postural Assessment Scale for Stroke Patients ( PASS ) , and the Modified Ashworth Scale ( MAS ) were administered by a blinded rater at baseline , posttreatment ( 8wk ) , and follow-up ( 12wk ) . RESULTS Twenty-three participants completed the study protocol and all outcome measurements . No preexisting group differences between the experimental group ( n=11 ) and the control group ( n=12 ) were found on demographic and clinical variables . Compared with baseline , the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM , Mob-STREAM , FAC , and BI ( P<.05 ) while the control group showed no significant improvements for all outcome measures . As for the between-group comparison , significant differences were seen at follow-up ( 12wk ) on the LE-STREAM , Mob-STREAM , BI , and MAS . CONCLUSIONS Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months Objective : To investigate the effect of perceptual learning exercises for hardness discrimination by the soles on st and ing balance in stroke patients with hemiplegia . Subjects : Twenty-eight subjects were r and omly assigned to an experimental or a control group and participated in a rehabilitation programme . Intervention : The experimental group received perceptual learning exercises on hardness discrimination using three different levels of hardness of a rubber sponge for 10 days . Main measures : Length , enveloped area and rectangular area of the parameter of postural sway were measured by a stabilometer on entry into the study and after 10 days . Results : Twenty-six subjects completed the study . Data indicate that more parameters indicating postural sway were significantly decreased in the experimental group than in the control group . Also , there was a significant difference between the groups in change scores ( pre-exercise minus postexercise ) of length and enveloped area . Conclusion : The plantar perception exercise used as a method in this study is considered to be effective as a supplemental exercise for st and ing balance . The possibility of clinical application using the hardness discrimination task with rubber as a balance exercise is therefore suggested It has been proposed that somatosensory input in the form of peripheral nerve stimulation can influence functional measures of motor performance . We studied the effects of median nerve stimulation on pinch muscle strength ( a function mediated predominantly by median nerve innervated muscles ) in the affected h and of chronic stroke patients . A 2‐hour period of median nerve stimulation elicited an increase in pinch strength that outlasted the stimulation period . The improvement in muscle strength correlated with stimulus intensity and was identified in the absence of motor training . These results suggest that somatosensory stimulation may be a promising adjuvant to rehabilitation of the motor deficits in stroke patients OBJECTIVE To determine the effects of a sensory retraining protocol on sensation , postural control , and gait in acute stroke subjects . DESIGN R and omized controlled pilot trial . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Twenty-one subjects with sensory deficits in the feet , undergoing rehabilitation for stroke . INTERVENTION Sensory retraining of the more affected lower limb versus relaxation ( sham intervention ) . MAIN OUTCOME MEASURES Light touch at the sole of the foot ( Semmes-Weinstein monofilaments ) , proprioception ( Distal Proprioception Test ) , postural control ( Berg Balance Scale ) , and gait ( timed , Iowa Level of Assistance Scale ) . RESULTS Significant improvements ( P<.05 ) over time were found in light touch at 3 points of the feet and in postural control , timed gait , and walking aid . No significant time effects were observed in proprioception or amount of assistance required to walk . No significant differences were detected between groups in any of the outcome variables , apart from light touch at the first metatarsal . The study had poor power ( 13 % ) to detect group effects due to the small sample size . CONCLUSIONS Results of this pilot study are unable to support or refute the routine use of sensory retraining of the lower limb for people during inpatient rehabilitation after stroke . Further research with a larger sample size is required Stein J , Hughes R , D ' And rea S , Therrien B , Niemi J , Krebs K , Langone L , Harry J : Stochastic resonance stimulation for upper limb rehabilitation poststroke . Objectives : Previous studies have shown that subthreshold electrical or mechanical noise can reduce the sensory threshold and impart short-term improvements in sensorimotor function . We undertook this study to examine the effects of combined subsensory electrical and vibratory stimulation in conjunction with exercise training on long-term motor performance . Design : Thirty subjects were recruited from adult community-dwelling stroke survivors with residual hemiparesis . Subjects were screened for residual motor ability using a functional task , and those who functioned below this level were excluded . All subjects had a history of a single unilateral ischemic or hemorrhagic stroke at least 6 mos before study entry and were not actively receiving occupational or physical therapy . Subjects were stratified by baseline upper extremity Fugl-Meyer ( UEFM ) ( more impaired [ 28–35 ] and less impaired [ 36–55 ] ) and were r and omized to one of two groups : treatment ( stochastic resonance stimulation [ plus over minus sign ] exercise : 15 subjects ) and control ( sham stimulation [ plus over minus sign ] exercise : 15 subjects ) . Results : No significant difference was found between the stochastic resonance treatment and control group in the UEFM or in any of the secondary measures . The combined group showed modest improvements in UEFM from baseline to completion of therapy ( mean improvement , 2.6 points ) ( P = 0.004 ) ; however , these improvements declined by 1-mo follow-up to 1.5 points ( P = 0.055 ) . No change in sensory function was detectable . Conclusions : Stochastic resonance therapy combined with occupational therapy was no more effective than occupational therapy alone in restoring sensorimotor performance . Other stochastic resonance stimulation montages or protocol s might prove more effective Objective : To evaluate the effectiveness of thermal stimulation accompanied by either active or passive movement added to st and ard rehabilitation in facilitating motor and balance function of the paretic leg of acute stroke . Design : Pilot , observer-blinded , r and omized clinical trial . Setting : Department of rehabilitation medicine in a general hospital . Subjects : Thirty-six patients were enrolled within four weeks of the onset of a stroke causing moderate to severe leg paresis ( Brunnstrom stage ≤III ) . Interventions : Patients were r and omly assigned to thermal ( st and ard rehabilitation plus approximately 30–40 minutes of thermal stimulation therapy daily for six weeks ) and control ( st and ard rehabilitation only ) groups . Main measures : Fugl – Meyer lower extremity score , Medical Research Council scale for lower extremity , Modified Motor Assessment Scale , Postural Assessment Scale for Stroke Patients Trunk Control , Berg Balance Scale , Functional Ambulation Classification and Modified Ashworth Scale . Results : Patients in the thermal group experienced significantly better median scores for Fugl – Meyer lower extremity ( 14.0 ; interquartile range , 10.5–15.5 ) , Medical Research Council scale for lower extremity ( 6.0 ; 4.0–7.0 ) , Modified Motor Assessment Scale ( 16.0 ; 12.5–18.5 ) , Berg Balance Scale ( 28.0 ; 20.5–33.5 ) , and Functional Ambulation Classification ( 2.0 ; 2.0–2.0 ) ( all P < 0.05 ) . The thermal group also had more independent walkers ( 15/17 ; 88.2 % ) than the control group ( 9/16 ; 56.3 % ) after six weeks ( P = 0.06 ) . No adverse effect occurred . Conclusions : Thermal stimulation accompanied by either manual facilitation or encouragement for active participation of the paretic lower limb may be an effective promising supplementary treatment for the early-phase rehabilitation of moderate to severe stroke that warrants additional study Objective : To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation . Design : A pilot r and omized crossover trial . Setting : Two rehabilitation hospitals . Subjects : Twenty-two patients with subacute stroke . Interventions : Participants were r and omly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation . The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week , followed by another week with task-oriented training alone . The delayed group underwent the same training in reverse order . Main measures : Outcome measures were the level of fatigue and Wolf Motor Function Test . Patients were assessed at baseline , one and two weeks . Results : All participants completed the study with no adverse events . There was no significant difference in level of fatigue between each treatment . From baseline to one week , the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test ( decrease in mean time ( ± SD ) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds , respectively ) but the difference did not reach significance after Bonferroni correction ( P = 0.041 ) . Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01 ) . Conclusion : Peripheral sensory nerve stimulation is feasible in clinical setting s and may enhance the effects of task-oriented training in patients with subacute stroke Background . Previous works showed potentially beneficial effects of a single session of peripheral nerve sensory stimulation ( PSS ) on motor function of a paretic h and in patients with subacute and chronic stroke . Objective . To investigate the influence of the use of different stimulus intensities over multiple sessions ( repetitive PSS [ RPSS ] ) paired with motor training . Methods . To address this question , 22 patients were r and omized within the second month after a single hemispheric stroke in a parallel design to application of 2-hour RPSS at 1 of 2 stimulus intensities immediately preceding motor training , 3 times a week , for 1 month . Jebsen — Taylor test ( JTT , primary endpoint measure ) , pinch force , Functional Independence Measure ( FIM ) , and corticomotor excitability to transcranial magnetic stimulation were measured before and after the end of the treatment month . JTT , FIM scores , and pinch force were reevaluated 2 to 3 months after the end of the treatment . Results . Baseline motor function tests were comparable across the 2 RPSS intensity groups . JTT improved significantly in the lower intensity RPSS group but not in the higher intensity RPSS group at month 1 . This difference between the 2 groups reduced by months 2 to 3 . Conclusions . These results indicate that multiple sessions of RPSS could facilitate training effects on motor function after subacute stroke depending on the intensity of stimulation . It is proposed that careful dose — response studies are needed to optimize parameters of RPSS stimulation before design ing costly , larger , double-blind , multicenter clinical trials
Background : Reduced sensation is experienced by one in two individuals following stroke , impacting both the ability to function independently and overall quality of life .
Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity , indicating a potential mechanism which may mediate recovery .
However , rehabilitation specifically focusing on somatosensory function receives little attention .
Objectives : To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke .