Dose-response effects of peripheral nerve stimulation and motor training in stroke: Preliminary data

Stroke is one of the most devastating and prevalent diseases. However, efforts to limit tissue damage in acute stroke have met with only minimal success. Therefore, it is of paramount importance to establish effective therapies for use during long-term stages of recovery. Such therapy can capitalize on neuroplastic change (brain reorganization), which has been associated with recovery of function after brain lesions. Intensive, repetitive motor training is a therapeutic intervention that has been shown to support neuroplastic change and improve motor performance after stroke. Likewise, sensory input in the form of peripheral nerve stimulation (PNS) has been shown to upregulate neuroplasticity and improve motor performance after stroke. However, no studies have evaluated how pairing intensive motor training with various PNS intensities and times may affect motor performance, particularly for subjects with severe upper extremity (UE) hemiparesis after stroke. Here, we describe our ongoing study of whether various intensities and times of delivery of PNS relative to motor training will yield differential effects on UE motor function in subjects with chronic, severe motor deficit after stroke. Our results will facilitate development of a dose-response model for PNS paired with intensive, repetitive motor training, which will help optimize this combinatory intervention for stroke survivors with highest need.

[1]  K. Furie,et al.  Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2008, Circulation.

[2]  Lumy Sawaki,et al.  Effects of Somatosensory Stimulation on Use-Dependent Plasticity in Chronic Stroke , 2006, Stroke.

[3]  L. Cohen,et al.  Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. , 2007, Archives of physical medicine and rehabilitation.

[4]  P. Thompson,et al.  Motor cortex stimulation in intact man. 1. General characteristics of EMG responses in different muscles. , 1987, Brain : a journal of neurology.

[5]  Felipe Fregni,et al.  Updates on the use of non-invasive brain stimulation in physical and rehabilitation medicine. , 2009, Journal of rehabilitation medicine.

[6]  H. Flor,et al.  Plasticity in the motor system related to therapy-induced improvement of movement after stroke. , 1999, Neuroreport.

[7]  Lumy Sawaki,et al.  Modulation of human corticomotor excitability by somatosensory input , 2002, The Journal of physiology.

[8]  L. Cohen,et al.  Increase in hand muscle strength of stroke patients after somatosensory stimulation , 2002, Annals of neurology.

[9]  L. Cohen,et al.  Transcranial DC stimulation (tDCS): A tool for double-blind sham-controlled clinical studies in brain stimulation , 2006, Clinical Neurophysiology.

[10]  M. Magistris,et al.  Assessment of central motor conduction to intrinsic hand muscles using the triple stimulation technique: normal values and repeatability , 2004, Clinical Neurophysiology.

[11]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[12]  Á. Pascual-Leone,et al.  Technology Insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS , 2007, Nature Clinical Practice Neurology.

[13]  D. Arciniegas,et al.  Constraint-induced therapy for moderate chronic upper extremity impairment after stroke , 2005, Brain injury.

[14]  M. Hallett.  Functional reorganization after lesions of the human brain: studies with transcranial magnetic stimulation. , 2001, Revue neurologique.

[15]  Leonardo G. Cohen,et al.  Effects of Somatosensory Stimulation on Motor Function After Subacute Stroke , 2010, Neurorehabilitation and neural repair.

[16]  R. Nudo,et al.  Cortical plasticity after stroke: implications for rehabilitation. , 1999, Revue neurologique.

[17]  J. Liepert,et al.  Treatment-induced cortical reorganization after stroke in humans. , 2000, Stroke.

[18]  B. Johansson,et al.  Brain plasticity and stroke rehabilitation , 2008 .

[19]  Ann M. Stowe,et al.  Extensive Cortical Rewiring after Brain Injury , 2005, The Journal of Neuroscience.

[20]  E. Taub,et al.  A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke , 2006, Stroke.

[21]  B. Johansson.  Brain plasticity and stroke rehabilitation. The Willis lecture. , 2000, Stroke.

[22]  R. Nudo.  Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. , 2003, Journal of rehabilitation medicine.

[23]  R. Nudo,et al.  Role of adaptive plasticity in recovery of function after damage to motor cortex , 2001, Muscle & nerve.

[24]  S. Wolf,et al.  The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study , 2004, Neurorehabilitation and neural repair.

[25]  S. Nelson,et al.  Hebb and homeostasis in neuronal plasticity , 2000, Current Opinion in Neurobiology.

[26]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[27]  S. Potashner,et al.  Long‐term degeneration in the cochlear nerve and cochlear nucleus of the adult chinchilla following acoustic overstimulation , 1998, Microscopy research and technique.

[28]  K. M. Anderson,et al.  Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia. , 2003, Physical therapy.

[29]  F L Mastaglia,et al.  Raised corticomotor excitability of M1 forearm area following anodal tDCS is sustained during robotic wrist therapy in chronic stroke. , 2009, Restorative neurology and neuroscience.

[30]  Timothy S Miles,et al.  Changes in corticomotor representations induced by prolonged peripheral nerve stimulation in humans , 2001, Clinical Neurophysiology.

[31]  J. Rothwell,et al.  Sensorimotor modulation of human cortical swallowing pathways , 1998, The Journal of physiology.

[32]  J Kimura,et al.  Collision technique , 1976, Neurology.

[33]  Myoung-Hwan Ko,et al.  Enhancing the Working Memory of Stroke Patients Using tDCS , 2009, American journal of physical medicine & rehabilitation.

[34]  L. Cohen,et al.  Improvement of Motor Function with Noninvasive Cortical Stimulation in a Patient with Chronic Stroke , 2005, Neurorehabilitation and neural repair.

[35]  J. P. Miller,et al.  Methods for a Multisite Randomized Trial to Investigate the Effect of Constraint-Induced Movement Therapy in Improving Upper Extremity Function among Adults Recovering from a Cerebrovascular Stroke , 2003, Neurorehabilitation and neural repair.

[36]  E. Taub,et al.  Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. , 1999, Journal of rehabilitation research and development.

[37]  J C Rothwell,et al.  Further observations on the facilitation of muscle responses to cortical stimulation by voluntary contraction. , 1991, Electroencephalography and clinical neurophysiology.

[38]  Wasuwat Kitisomprayoonkul,et al.  Increased Pinch Strength in Acute and Subacute Stroke Patients After Simultaneous Median and Ulnar Sensory Stimulation , 2009, Neurorehabilitation and neural repair.

[39]  S. Wolf,et al.  Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients , 1989, Experimental Neurology.