title: Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke: A Randomized Trial.
abstract: A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement).
  
  
  
  Subjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up.
  
  
  
  Statistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, -0.21 to -0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, 0.6-8.4; P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on ≥1 outcomes at ≥1 time points after intervention.
  
  
  
  After stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02633215.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carrico
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Chelette
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Philip M
authors.initials: PM
authors.lastname: Westgate
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Powell
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Laurie
authors.initials: L
authors.lastname: Nichols
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
authors.forename: Anne
authors.initials: A
authors.lastname: Fleischer
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.). lsawa2@uky.edu.
authors.forename: Lumy
authors.initials: L
authors.lastname: Sawaki
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D011597:Psychomotor Performance; D011826:Radial Nerve; D020127:Recovery of Function; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: occupational therapy; rehabilitation; stroke; upper extremity