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 randomised controlled trial (ISRCTN 05542931), 33 patients (mean 37.7 months post-stroke) were block randomised to two groups: active or sham SS. They received 12 sessions of 2 hours of SS (active or sham) to all three 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 (TMS) stimulus-response curves and intracortical inhibition. Outcomes were assessed at baseline, immediately following the intervention (mean 2 days), 3 and 6 months (mean 96 & 190 days).
Results: The active group (n= 16) demonstrated greater improvement in ARAT score and time immediately post-intervention (between-group difference; p< 0.05), but not at 3 or 6 month follow ups (p> 0.2). Within-group improvements were seen for ARAT, GAS and MAL (p< 0.05), but there were no FM or TMS changes.
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.
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 randomised controlled trial (ISRCTN 05542931), 33 patients (mean 37.7 months post-stroke) were block randomised to two groups: active or sham SS. They received 12 sessions of 2 hours of SS (active or sham) to all three 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 (TMS) stimulus-response curves and intracortical inhibition. Outcomes were assessed at baseline, immediately following the intervention (mean 2 days), 3 and 6 months (mean 96 & 190 days).
Results: The active group (n= 16) demonstrated greater improvement in ARAT score and time immediately post-intervention (between-group difference; p< 0.05), but not at 3 or 6 month follow ups (p> 0.2). Within-group improvements were seen for ARAT, GAS and MAL (p< 0.05), but there were no FM or TMS changes.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 143-152 |
| Number of pages | 10 |
| Journal | Neurorehabilitation and Neural Repair |
| Volume | 29 |
| Issue number | 2 |
| Early online date | 6 May 2014 |
| DOIs | |
| Publication status | Published - 1 Feb 2015 |
Keywords
- Stroke, Somatosensory Stimulation, Upper Limb, Task Specific Training, Rehabilitation, Transcranial Magnetic Stimulation