Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. A randomized controlled trial of Cognitive Sensory Motor Training Therapy on the recovery of arm function in acute stroke patients Increased Pinch Strength in Acute and Subacute Stroke Patients After Simultaneous Median and Ulnar Sensory Stimulation Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute 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 Early and Repetitive Stimulation of the Arm Can Substantially Improve the Long-Term Outcome After Stroke: A 5-Year Follow-up Study of a Randomized Trial Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke 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 Modulation of human corticomotor excitability by somatosensory input. Combining Afferent Stimulation and Mirror Therapy for Rehabilitating Motor Function, Motor Control, Ambulation, and Daily Functions After Stroke Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial 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 Associative pairing of tactile stimulation induces somatosensory cortical reorganization in rats and humans Combining Afferent Stimulation and Mirror Therapy for Improving Muscular, Sensorimotor, and Daily Functions After Chronic Stroke: A Randomized, Placebo-Controlled Study Stochastic Resonance Stimulation for Upper Limb Rehabilitation Poststroke Effects of Somatosensory Stimulation on Motor Function After Subacute Stroke
BACKGROUND AND PURPOSE Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm 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 . 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 BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months 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 Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke . Subjects and Methods — One hundred consecutive stroke patients were r and omly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group . The intervention period was 6 weeks . Assessment s of the patients were made before , midway , and after intervention , and at 6 and 12 months after stroke . In this study , 62 patients were reassessed at 5 years after stroke . The Brunnström-Fugl-Meyer ( BFM ) test , Action Research Arm ( ARA ) test , and Barthel index ( BI ) were used as the primary outcome measures . Results — At the 5-year follow-up , there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group . The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA . No effect was found for the BI . The treatment was most effective in patients with a severe initial motor deficit . Conclusions — Adding a specific intervention for the arm during the acute phase after a stroke result ed in a clinical ly meaningful and long-lasting effect on motor function . The effect can be attributed to early , repetitive , and targeted stimulation 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 h and and eight received no-current placebo treatment in the paretic h and . 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 : Modified Motor Assessment Scale , 10-metre walking test , paretic limb function , limb skin sensation and somatosensory evoked potentials ( SEP ) were performed before and after the treatment . Results : Modified Motor Assessment Scale ( p < 0.001 ) , 10-metre walking test ( p < 0.05 ) , paretic h and function ( p < 0.01 ) , upper limb skin sensation ( p < 0.01 ) and SEP normality classification of paretic upper limb ( p < 0.01 ) and paretic lower limb ( p < 0.5 ) improved significantly in the treatment group ( n = 51 ) after three weeks of stimulation . When active h and treatment and placebo h and treatment were compared , a significant 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 configuration of SEP of the paretic limb in chronic stroke patients 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 In humans , somatosensory stimulation results in increased corticomotoneuronal excitability to the stimulated body parts . The purpose of this study was to investigate the underlying mechanisms . We recorded motor evoked potentials ( MEPs ) to transcranial magnetic stimulation ( TMS ) from abductor pollicis brevis ( APB ) , first dorsal interosseous ( FDI ) , and abductor digiti minimi ( ADM ) muscles . MEP amplitudes , recruitment curves ( RC ) , intracortical inhibition ( ICI ) , intracortical facilitation ( ICF ) , resting ( rMT ) and active motor thresholds ( aMT ) were recorded before and after a 2-h period of ulnar nerve electrical stimulation at the wrist . Somatosensory input was monitored by recording somatosensory evoked potentials . To differentiate excitability changes at cortical vs. subcortical sites , we recorded supramaximal peripheral M-responses and MEPs to brainstem electrical stimulation ( BES ) . In order to investigate the involvement of GABAergic mechanisms , we studied the influence of lorazepam ( LZ ) ( a GABA(A ) receptor agonist ) relative to that of dextromethorphan ( DM ) ( an NMDA receptor antagonist ) and placebo in a double-blind design . We found that somatosensory stimulation increased MEP amplitudes to TMS only in the ADM , confirming a previous report . This effect was blocked by LZ but not by either DM or placebo and lasted between 8 and 20 min in the absence of ( i ) changes in MEPs elicited by BES , ( ii ) amplitudes of early somatosensory-evoked potentials or ( iii ) M-responses . We conclude that somatosensory stimulation elicited a focal increase in corticomotoneuronal excitability that outlasts the stimulation period and probably occurs at cortical sites . The antagonistic effect of LZ supports the hypothesis of GABAergic involvement as an operating mechanism 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 Objectives : To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm . Design : Double-blind , r and omized , placebo-controlled trial . Setting : Acute stroke wards , followed by rehabilitation hospitals and subjects ’ residences . Participants : Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke . Intervention : All subjects received conventional rehabilitation . Twenty-nine received additional electrical stimulation , 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only , as control . Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20 , LI15 , LI11 , LI10 and LI4 , 60 minutes a day , five days a week , for four weeks . Measurements : Primary outcome measures were h and grip and pinch strength , with Action Research Arm Test ( ARAT ) as secondary outcome measure . These were assessed on the affected arm at recruitment , then 4 ( W4 ) , 12 ( W12 ) and 24 weeks ( W24 ) afterwards . Results : Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in h and grip ( P = 0.015 ) and pinch strength ( P = 0.007 ) at W4 , with the gains maintained at W12 and W24 . In contrast , the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group . Between-group improvements in ARAT scores from baseline to W24 ( by 16.8 in control , 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group ) were not significant . Conclusions : Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting h and grip and pinch strength improvements than administering conventional rehabilitation alone 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 WE used a protocol of associative ( Hebbian ) pairing of tactile stimulation ( APTS ) to evoke cortical plastic changes . Reversible reorganization of the adult rat paw representations in somatosensory cortex(SI ) induced by a few hours of APTS included selective enlargement of the areas of cortical neurones representing the stimulated skin fields and of the corresponding receptive fields ( RFs ) . Late , presumably NMDA receptor-mediated response components were enhanced , indicating an involvement of glutamatergic synapses . A control protocol of identical stimulus pattern applied to only a single skin site revealed no changes of RFs , indicating that co-activation is crucial for induction . Using an analogous APTS protocol in humans revealed an increase of spatial discrimination performance indicating that fast plastic processes based on co-activation patterns act on a cortical and perceptual level Objective Mirror therapy ( MT ) combined with mesh glove ( MG ) afferent stimulation ( MT + MG ) has been suggested as an effective intervention for motor recovery in patients with stroke . This study aim ed to further determine the treatment effects of the MT + MG approach on muscular properties , sensorimotor functions , and daily function . Design This was a single-blind , r and omized , placebo-controlled study . Forty-eight participants with chronic stroke were recruited from medical centers and were r and omly assigned to the MT , MT + MG , and MT with sham MG stimulation ( MT + sham ) groups . The intervention consisted of 1.5 hrs/day , 5 days/wk for 4 wks . Primary outcomes were the Fugl-Meyer Assessment and muscular properties ( muscle tone and stiffness ) . Secondary outcomes included measures of sensorimotor and daily functions . Results Compared with the MT and MT + sham groups , the MT + MG group demonstrated improved muscular properties . The MT + MG and MT + sham groups showed greater improvement in manual dexterity and daily function than the MT group did . No beneficial effects on the Fugl-Meyer Assessment and other sensorimotor outcomes were found for the MT + MG group . Conclusions Although no significant group differences were found in the Fugl-Meyer Assessment , MT + MG induced distinctive effects on muscular properties , manual dexterity , and daily function 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 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
Abstract Background Somatosensory stimulation may have a positive impact on recovery of motor function by maintaining cortical representation of the h and and acting to prime the motor system for movement .
Objective Determine the efficacy of somatosensory stimulation on upper limb motor function after stroke .