title: The effect of combined somatosensory stimulation and task-specific training on upper limb function in chronic stroke: a double-blind randomized controlled trial.
abstract: BACKGROUND
  Somatosensory stimulation (SS) is a potential adjuvant to stroke rehabilitation, but the effect on function needs further investigation.
  
  
  OBJECTIVE
  To explore the effect of combining SS with task-specific training (TST) on upper limb function and arm use in chronic stroke survivors and determine underlying mechanisms.
  
  
  METHODS
  In this double-blinded randomized controlled trial (ISRCTN 05542931), 33 patients (mean 37.7 months poststroke) were block randomized to 2 groups: active or sham SS. They received 12 sessions of 2 hours of SS (active or sham) to all 3 upper limb nerves immediately before 30 minutes of TST. The primary outcome was the Action Research Arm Test (ARAT) score. Secondary outcomes were time to perform the ARAT, Fugl-Meyer Assessment score (FM), Motor Activity Log (MAL), and Goal Attainment Scale (GAS). Underlying mechanisms were explored using transcranial magnetic stimulation stimulus-response curves and intracortical inhibition. Outcomes were assessed at baseline, immediately following the intervention (mean 2 days), and 3 and 6 months (mean 96 and 190 days) after the intervention.
  
  
  RESULTS
  The active group (n = 16) demonstrated greater improvement in ARAT score and time immediately postintervention (between-group difference; P < .05), but not at 3- or 6-month follow-ups (P > .2). Within-group improvements were seen for both groups for ARAT and GAS, but for the active group only for FM and MAL (P < .05). Corticospinal excitability did not change.
  
  
  CONCLUSIONS
  Long-lasting improvements in upper limb function were observed following TST. Additional benefit of SS was seen immediately post treatment, but did not persist and the underlying mechanisms remain unclear.
authors.affiliation: School of Biomedical Sciences, King's College London, London, UK.
authors.forename: Melanie K
authors.initials: MK
authors.lastname: Fleming
authors.affiliation: School of Medicine, King's College London, London, UK isaac.2.sorinola@kcl.ac.uk.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Sorinola
authors.affiliation: School of Biomedical Sciences, King's College London, London, UK School of Medicine, King's College London, London, UK.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Roberts-Lewis
authors.affiliation: School of Medicine, King's College London, London, UK National Institute for Health Research Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Wolfe
authors.affiliation: School of Medicine, King's College London, London, UK National Institute for Health Research Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Wellwood
authors.affiliation: School of Biomedical Sciences, King's College London, London, UK.
authors.forename: Di J
authors.initials: DJ
authors.lastname: Newham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology; D002908:Chronic Disease; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods; D019054:Evoked Potentials, Motor; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: electrical stimulation; neurophysiology; rehabilitation; stroke; task-specific training; upper extremity