Date Presented 03/26/20
We conducted a phase I pilot randomized controlled trial examining the preliminary efficacy of combining brain and hand stimulation to improve hand function in individuals with moderate to severe chronic stroke. Our findings suggest that the combined brain and hand stimulation shows promise in improving hand movement, function, and participation in daily tasks in this population. Future studies are warranted to examine the efficacy of this intervention.
Primary Author and Speaker: Amit Sethi
Contributing Authors: Alvaro Pascual-Leone, Emiliano Santarnecchi
INTRODUCTION: Among the 795,000 individuals who sustain a stroke annually in the United States, 65% continue to experience severe impairments in one upper extremity six months after stroke, limiting their ability to perform daily tasks. Currently there are no effective interventions to improve hand function in moderate-to-severe chronic stroke. Using the principles of neuroplasticity, we developed a novel intervention, which combines non-invasive brain stimulation with functional electrical hand stimulation for individuals with moderate-to-severe impairments. The purpose of this study was to investigate the preliminary efficacy of this intervention in individuals with chronic stroke.
DESIGN: Phase I pilot randomized clinical trial. Participants were randomly selected and allocated to two groups - 8 participants in the experimental group received real brain stimulation, and 8 participants in the control group received sham stimulation. Both groups practiced meaningful tasks with hand stimulation. 16 Participants within 40-80 years with single episode of stroke ranging from moderate-to-severe upper extremity impairments (less than 20 degrees of active extension) were selected.
METHODS: All participants received a total of 18 treatment sessions three times a week for 6 weeks. Each treatment session lasted for 1 hour 30 minutes where participants practiced grasping and releasing meaningful objects (15 minutes each) with the functional electrical stimulation of the weak hand. Simultaneously, we delivered the non-invasive brain stimulation via weak random noise currents to stimulate the damaged motor cortex for the first 30 minutes. We assessed the preliminary efficacy using impairment of hand movement [Fugl Meyer Upper Extremity Subscale (FMUE)], activity limitations in the function use of the hand [Wolf Motor Function Test (WMFT)] and participation [Stroke Impact Scale(SIS)].
RESULTS: The participants who received real brain stimulation showed significantly greater improvement in hand movement (FMUE) (t = 1.9; p = .04), functional use of hand WMFT (t = 2.1; p = .03) and participation (SIS) (t = 1.9; p = .04).
CONCLUSION: The combined brain and hand stimulation shows promise in improving hand movement, function and participation in daily tasks in this population. Future studies are warranted to examine the efficacy of this intervention.
References
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Nair, D.G., V. Renga, R. Lindenberg, L. Zhu, & G. Schlaug (2011). Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS. Restorative Neurological and Neuroscience, 29(6): 411-20. doi: 10.3233/RNN-2011-0612
