title: Home-based nerve stimulation to enhance effects of motor training in patients in the chronic phase after stroke: a proof-of-principle study.
abstract: 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.
  
  
  OBJECTIVE
  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 hand motor function in patients in the chronic phase after stroke.
  
  
  METHODS
  Twenty patients were randomized 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 hand 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.
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Renata Laurenti
authors.initials: RL
authors.lastname: Dos Santos-Fontes
authors.forename: Karina Nocelo
authors.initials: KN
authors.lastname: Ferreiro de Andrade
authors.forename: Annette
authors.initials: A
authors.lastname: Sterr
authors.forename: Adriana Bastos
authors.initials: AB
authors.lastname: Conforto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001703:Biophysics; D002908:Chronic Disease; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008475:Median Nerve / Q000502:physiology*; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D034941:Upper Extremity / Q000503:physiopathology; D014953:Wrist / Q000294:innervation; D055815:Young Adult
keywords: hemiparesis; motor activity; peripheral nerve stimulation therapy; physical therapy; stroke rehabilitation