Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury.
OBJECTIVE
To assess single-session effects of three different types of stimuli known to increase cortical excitability when combined with functional task practice.


METHODS
Randomized cross-over trial.


METHODS
A total of 24 participants with chronic cervical spinal cord injury.


METHODS
One 30-minute session of each, applied concurrently with functional task practice: transcranial direct current stimulation, vibration, and transcutaneous electrical nerve stimulation.


METHODS
Nine-hole Peg Test, pinch force, visuomotor tracking, and cortical excitability were collected at pretest, posttest and late posttest (30 minutes after). Early effects (posttest minus pretest) and short-term persistence (late posttest minus pretest) were assessed using a general linear mixed model. Magnitude of effect size was assessed using the Cohen's d.


RESULTS
Transcutaneous electrical nerve stimulation was associated with moderate, significant early effects and short-term persistence on Nine-hole Peg Test performance (1.8 ±1.8, p = 0.003, d = 0.59; 2.0 ±2.5, p < 0.001, Cohen's d = 0.65, respectively). Transcranial direct current stimulation (1.8 ±2.5, p = 0.003, Cohen's d = 0.52) was also associated with significant short-term persistence of moderate size on Nine-hole Peg Test performance (1.8 ±2.5, p = 0.003, Cohen's d = 0.52) and visuomotor tracking performance (p = 0.05, d = 0.51). Early effects on corticomotor excitability were significant for transcutaneous electrical nerve stimulation (p = 0.003), approached significance for transcranial direct current stimulation (p = 0.07), and only vibration was associated with significant short-term persistence (p = 0.006).


CONCLUSIONS
Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.
The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA.
Joyce
J
Gomes-Osman
The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA edee@miami.edu.
Edelle C
EC
Field-Fote
D000328:Adult; D002574:Cervical Vertebrae; D002908:Chronic Disease; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010865:Pilot Projects; D052581:Pinch Strength; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D065908:Transcranial Direct Current Stimulation; D004561:Transcutaneous Electric Nerve Stimulation; D014732:Vibration / Q000627:therapeutic use*
Cervical spinal cord injury; functional task practice; transcranial direct current stimulation; transcutaneous electrical nerve stimulation; vibration