• Cheryl Carrico, Kenneth C Chelette, Philip M Westgate, Elizabeth Powell, Laurie Nichols, Anne Fleischer, and Lumy Sawaki.
• From the Department of Physical Medicine and Rehabilitation (C.C., K.C.C., E.P., L.N., L.S.) and Department of Biostatistics, College of Public Health (P.M.W.), University of Kentucky, Lexington; HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington (L.N., L.S.); Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond (A.F.); and Department of Neurology, Wake Forest University, Winston-Salem, NC (L.S.).
• Stroke. 2016 Jul 1; 47 (7): 1879-84.

Background And PurposeA sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement).MethodsSubjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up.ResultsStatistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, -0.21 to -0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, 0.6-8.4; P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on ≥1 outcomes at ≥1 time points after intervention.ConclusionsAfter stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02633215.© 2016 American Heart Association, Inc.

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