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Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Carrico, Cheryl MS, OT/L; Chelette, Kenneth C. II MS; Westgate, Philip M. PhD; Salmon-Powell, Elizabeth MS; Nichols, Laurie BS, OT/L; Sawaki, Lumy MD, PhD

American Journal of Physical Medicine & Rehabilitation: June 2016 - Volume 95 - Issue 6 - p 397–406
doi: 10.1097/PHM.0000000000000476
Original Research Articles CME Article . 2016 Series . Number 6
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Background Constraint-based therapy and peripheral nerve stimulation can significantly enhance movement function after stroke. No studies have investigated combining these interventions for cases of chronic, mild-to-moderate hemiparesis following stroke.

Objective This study aims to determine the effects of peripheral nerve stimulation paired with a modified form of constraint-induced therapy on upper extremity movement function after stroke. Nineteen adult stroke survivors with mild-to-moderate hemiparesis more than 12 mo after stroke received 2 hours of either active (n = 10) or sham (n = 9) peripheral nerve stimulation preceding 4 hours of modified constraint-induced therapy (10 sessions).

Results Active peripheral nerve stimulation enhanced modified constraint-induced therapy more than sham peripheral nerve stimulation (significance at P < 0.05), both immediately after intervention (Wolf Motor Function Test: P = 0.006 (timed score); P = 0.001 (lift score); Fugl-Meyer Assessment: P = 0.022; Action Research Arm Test: P = 0.007) and at 1-mo follow-up (Wolf Motor Function Test: P = 0.025 (timed score); P = 0.007 (lift score); Fugl-Meyer Assessment: P = 0.056; Action Research Arm Test: P = 0.028).

Conclusion Pairing peripheral nerve stimulation with modified constraint-induced therapy can lead to significantly more improvement in upper extremity movement function than modified constraint-induced therapy alone. Future research is recommended to help establish longitudinal effects of this paired intervention, particularly as it affects movement function and daily life participation.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives: Upon completion of this article, the reader should be able to: (1) Understand the role that afferent input plays with regard to movement function; (2) Understand general concepts of delivering modified constraint-based therapy in stroke rehabilitation research; and (3) Understand the rationale for applying an adjuvant intervention to optimize outcomes of constraint-based therapy following stroke.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Supplemental digital content is available in the text.

From the Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky (CC, KCC, ES-P, LN, LS); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (PMW); HealthSound Cardinal Hill Rehabilitation Hospital, Lexington, Kentucky (LN, LS); and Department of Neurology, Wake Forest University, Winston-Salem, North Carolina (LS).

All correspondence and requests for reprints should be addressed to: Lumy Sawaki, MD, PhD, Department of Physical Medicine and Rehabilitation at Cardinal Hill Hospital, University of Kentucky, 2050 Versailles Road, Lexington, KY 40504.

This study was funded by NIH R03 HD049408-01A1 as well as the Cardinal Hill Rehabilitation Hospital Endowed Chair in Stroke and Spinal Cord Injury Rehabilitation (0705129700). There are no financial benefits to the authors. Results of this study were first presented in poster form at the 2013 International Stroke Conference in conjunction with the Travel Award for Junior Investigators. The clinical trial registration number with clinicaltrials.gov is NCT02587234.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

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