Repetitive Peripheral Sensory Stimulation as an Add-On Intervention for Upper Limb Rehabilitation in Stroke: A Randomized Trial
Adriana B Conforto, André G Machado, Nathalia H V Ribeiro, Ela B Plow, Sook-Lei Liew, Claudia da Costa Leite, Artemis Zavaliangos-Petropulu, Isabella Menezes, Sarah M Dos Anjos, Rafael Luccas, Paul Hunter Peckham, Leonardo G Cohen, Adriana B Conforto, André G Machado, Nathalia H V Ribeiro, Ela B Plow, Sook-Lei Liew, Claudia da Costa Leite, Artemis Zavaliangos-Petropulu, Isabella Menezes, Sarah M Dos Anjos, Rafael Luccas, Paul Hunter Peckham, Leonardo G Cohen
Abstract
Introduction: Repetitive peripheral sensory stimulation (RPSS) followed by 4-hour task-specific training (TST) improves upper limb motor function in subjects with stroke who experience moderate to severe motor upper limb impairments. Here, we compared effects of RPSS vs sham followed by a shorter duration of training in subjects with moderate to severe motor impairments in the chronic phase after stroke.
Methods: This single-center, randomized, placebo-controlled, parallel-group clinical trial compared effects of 18 sessions of either 1.5 h of active RPSS or sham followed by a supervised session that included 45 min of TST of the paretic upper limb. In both groups, subjects were instructed to perform functional tasks at home, without supervision. The primary outcome measure was the Wolf Motor Function Test (WMFT) after 6 weeks of treatment. Grasp and pinch strength were secondary outcomes.
Results: In intention-to-treat analysis, WMFT improved significantly in both active and sham groups at 3 and 6 weeks of treatment. Grasp strength improved significantly in the active, but not in the sham group, at 3 and 6 weeks. Pinch strength improved significantly in both groups at 3 weeks, and only in the active group at 6 weeks.
Conclusions: The between-group difference in changes in WMFT was not statistically significant. Despite the short duration of supervised treatment, WMFT improved significantly in subjects treated with RPSS or sham. These findings are relevant to settings that impose constraints in duration of direct contact between therapists and patients. In addition, RPSS led to significant gains in hand strength.Trial Registry Name: Peripheral Nerve Stimulation and Motor Training in Stroke Clinical Trials.gov identifier: NCT0265878 https://ichgcp.net/clinical-trials-registry/NCT02658578.
Keywords: cerebrovascular accident; neuromodulation; rehabilitation; sensory; upper extremity.
Conflict of interest statement
Declaration of conflicting interests
Dr. Machado reports other from Enspire DBS, outside the submitted work. In addition, Dr. Machado has a patent 8,190,263 issued to Cleveland Clinic. Dr. Liew reports grants from the National Institutes of Health during the conduct of the study. Dr. Conforto, Dr. Ribeiro, Dr. Menezes, Dr. dos Anjos and Dr. Luccas received funding from the National Institutes of Health (grant R01NS076348-01) during the conduct of the study. The other authors declare that there are no conflicts of interest.
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Source: PubMed