title: Massed practice versus massed practice with stimulation: effects on upper extremity function and cortical plasticity in individuals with incomplete cervical spinal cord injury.
abstract: OBJECTIVE
  To determine the effect of massed practice (MP) versus massed practice combined with somatosensory stimulation (MP+SS) on cortical plasticity and function in persons with incomplete tetraplegia.
  
  
  METHODS
  Ten subjects were assigned to either MP or MP+SS. Median nerve stimulation (500 ms train, 10 Hz, 1 ms pulse duration) was delivered at the intensity eliciting a motor threshold response. Training sessions were 5 d/week for 3 weeks at 2 h/session. Outcome measures included 1) motor-evoked potentials (MEPs) elicited via transcranial magnetic stimulation (TMS), motor threshold (MT) and MEP amplitude at 1.2 MT; 2) maximal pinch grip force; 3) Wolf Motor Function Test (WMFT) and Jebsen Hand Function Test.
  
  
  RESULTS
  The MP+SS group demonstrated significant improvements (P < 0.05) in pinch grip strength (190%), WMFT scores (52%), and Jebsen test scores (33%), whereas the MP group demonstrated significant improvement (P < 0.05) only in Jebsen test scores (11%). No significant changes were detected in cortical excitability in the MP+SS or MP group.
  
  
  CONCLUSIONS
  The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP. Optimal stimulation paradigms and training methods are needed to further test this strategy.
authors.affiliation: The Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, FL 33136, USA.
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Beekhuizen
authors.forename: Edelle C
authors.initials: EC
authors.lastname: Field-Fote
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae; D004599:Electric Stimulation Therapy / Q000379:methods*; D019054:Evoked Potentials, Motor; D005260:Female; D006225:Hand / Q000294:innervation / Q000502:physiology; D018737:Hand Strength; D006801:Humans; D008280:Magnetics / Q000627:therapeutic use*; D008297:Male; D008475:Median Nerve / Q000502:physiology; D008875:Middle Aged; D009043:Motor Activity; D009473:Neuronal Plasticity / Q000502:physiology*; D010865:Pilot Projects; D011782:Quadriplegia / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D013003:Somatosensory Cortex / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*