title: Sensory stimulation augments the effects of massed practice training in persons with tetraplegia.
abstract: OBJECTIVE
  To compare functional changes and cortical neuroplasticity associated with hand and upper extremity use after massed (repetitive task-oriented practice) training, somatosensory stimulation, massed practice training combined with somatosensory stimulation, or no intervention, in persons with chronic incomplete tetraplegia.
  
  
  METHODS
  Participants were randomly assigned to 1 of 4 groups: massed practice training combined with somatosensory peripheral nerve stimulation (MP+SS), somatosensory peripheral nerve stimulation only (SS), massed practice training only (MP), and no intervention (control).
  
  
  METHODS
  University medical school setting.
  
  
  METHODS
  Twenty-four subjects with chronic incomplete tetraplegia.
  
  
  METHODS
  Intervention sessions were 2 hours per session, 5 days a week for 3 weeks. Massed practice training consisted of repetitive practice of functional tasks requiring skilled hand and upper-extremity use. Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold.
  
  
  METHODS
  Pre- and post-testing assessed changes in functional hand use (Jebsen-Taylor Hand Function Test), functional upper-extremity use (Wolf Motor Function Test), pinch grip strength (key pinch force), sensory function (monofilament testing), and changes in cortical excitation (motor evoked potential threshold).
  
  
  RESULTS
  The 3 groups showed significant improvements in hand function after training. The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group, but only the MP+SS group had a significant change in sensory scores compared with the control group. The MP+SS and MP groups had greater change in threshold measures of cortical excitability.
  
  
  CONCLUSIONS
  People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills. Somatosensory stimulation appears to be a valuable adjunct to training programs designed to improve hand and upper-extremity function in these subjects.
authors: Department of Veterans Affairs Medical Center, Miami, FL, USA.
authors: Kristina S
authors: KS
authors: Beekhuizen
authors: Edelle C
authors: EC
authors: Field-Fote
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004599:Electric Stimulation Therapy / Q000379:methods*; D019054:Evoked Potentials, Motor; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011782:Quadriplegia / Q000175:diagnosis / Q000534:rehabilitation*; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D013003:Somatosensory Cortex / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D034941:Upper Extremity