title: Effects of combined peripheral nerve stimulation and brain polarization on performance of a motor sequence task after chronic stroke.
abstract: OBJECTIVE
  Recent work demonstrated that application of peripheral nerve and cortical stimulation independently can induce modest improvements in motor performance in patients with stroke. The purpose of this study was to test the hypothesis that combining peripheral nerve stimulation (PNS) to the paretic hand with anodal direct current stimulation (tDCS) to the ipsilesional primary motor cortex (M1) would facilitate beneficial effects of motor training more than each intervention alone or sham (tDCS(Sham) and PNS(Sham)).
  
  
  METHODS
  Nine chronic stroke patients completed a blinded crossover designed study. In separate sessions, we investigated the effects of single applications of PNS+tDCS, PNS+tDCS(Sham), tDCS+PNS(Sham), and PNS(Sham)+tDCS(Sham) before motor training on the ability to perform finger motor sequences with the paretic hand.
  
  
  RESULTS
  PNS+tDCS resulted in a 41.3% improvement in the number of correct key presses relative to PNS(Sham)+tDCS(Sham), 15.4% relative to PNS+tDCS(Sham), and 22.7% relative to tDCS+PNS(Sham). These performance differences were maintained 1 and 6 days after the end of the training.
  
  
  CONCLUSIONS
  These results indicate that combining PNS with tDCS can facilitate the beneficial effects of training on motor performance beyond levels reached with each intervention alone, a finding of relevance for the neurorehabilitation of motor impairments after stroke.
authors.affiliation: Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA. pcelnik@jhmi.edu
authors.forename: Pablo
authors.initials: P
authors.lastname: Celnik
authors.forename: Nam-Jong
authors.initials: NJ
authors.lastname: Paik
authors.forename: Yves
authors.initials: Y
authors.lastname: Vandermeeren
authors.forename: Michael
authors.initials: M
authors.lastname: Dimyan
authors.forename: Leonardo G
authors.initials: LG
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001288:Attention / Q000502:physiology; D001921:Brain / Q000502:physiology*; D003131:Combined Modality Therapy; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D004599:Electric Stimulation Therapy; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000502:physiology; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology; D009483:Neuropsychological Tests; D010291:Paresis / Q000628:therapy; D010525:Peripheral Nerves / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology*; D012890:Sleep / Q000502:physiology; D020521:Stroke / Q000523:psychology* / Q000628:therapy*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000502:physiology