Effects of Repetitive Peripheral Sensory Stimulation in the Subacute and Chronic Phases After Stroke: Study Protocol for a Pilot Randomized Trial

Jéssica Borges Kroth, Benjamim Handfas, Glaucia Rodrigues, Francisco Zepeda, Marco Aurélio Oliveira, Danny J J Wang, Raymundo Machado de Azevedo Neto, Gisele Sampaio Silva, Edson Amaro Jr, Isaac Olubunmi Sorinola, Adriana Bastos Conforto, Jéssica Borges Kroth, Benjamim Handfas, Glaucia Rodrigues, Francisco Zepeda, Marco Aurélio Oliveira, Danny J J Wang, Raymundo Machado de Azevedo Neto, Gisele Sampaio Silva, Edson Amaro Jr, Isaac Olubunmi Sorinola, Adriana Bastos Conforto

Abstract

Background: Repetitive peripheral nerve sensory stimulation (RPSS) is a potential add-on intervention to motor training for rehabilitation of upper limb paresis after stroke. Benefits of RPSS were reported in subjects in the chronic phase after stroke, but there is limited information about the effects of this intervention within the 1st weeks or months. The primary goal of this study is to compare, in a head-to-head proof-of-principle study, the impact of a single session of suprasensory vs. subsensory RPSS on the upper limb motor performance and learning in subjects at different phases after stroke subacute and chronic phases and mild upper limb motor impairments after stroke. In addition, we examine the effects of RPSS on brain perfusion, functional imaging activation, and γ-aminobutyric acid (GABA) levels. Subjects with mild upper limb motor impairments will be tested with MRI and clinical assessment either at an early (7 days to 3 months post-stroke) or at a chronic (>6 months) stage after stroke.

Methods: In this multicenter, randomized, parallel-group, proof-of-principle clinical trial with blinded assessment of outcomes, we compare the effects of one session of suprasensory or subsensory RPSS in patients with ischemic or hemorrhagic stroke and upper limb paresis. Clinical assessment and MRI will be performed only once in each subject (either at an early or at a chronic stage). The primary outcome is the change in performance in the Jebsen-Taylor test. Secondary outcomes: hand strength, cerebral blood flow assessed with arterial spin labeling, changes in the blood oxygenation level-dependent (BOLD) effect in ipsilesional and contralesional primary motor cortex (M1) on the left and the right hemispheres assessed with functional MRI (fMRI) during a finger-tapping task performed with the paretic hand, and changes in GABA levels in ipsilesional and contralesional M1 evaluated with spectroscopy. The changes in outcomes will be compared in four groups: suprasensory, early; subsensory, early; suprasensory, chronic; and subsensory, chronic.

Discussion: The results of this study are relevant to inform future clinical trials to tailor RPSS to patients more likely to benefit from this intervention.

Trial registration: NCT03956407.

Keywords: nerve stimulation; rehabilitation; sensory stimulation; stroke; upper limb.

Conflict of interest statement

DW was a shareholder of Translational MRI LLC, which provided the software for post-processing of pCASL data. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Kroth, Handfas, Rodrigues, Zepeda, Oliveira, Wang, Azevedo Neto, Silva, Amaro, Sorinola and Conforto.

Figures

Figure 1
Figure 1
Experimental paradigm. NIH, national institutes of health; PHQ-9, patient health questionnaire-9; MMSE, mini-mental state exam; MRI, magnetic resonance imaging; RPSS, repetitive peripheral nerve sensory stimulation; JTT, jebsen–taylor test.

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