Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 11 , Pages 1369-1376, November 2007

Somatosensory Stimulation Enhances the Effects of Training Functional Hand Tasks in Patients With Chronic Stroke

  • Pablo Celnik, MD

      Affiliations

    • Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    • Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University, Baltimore, MD
    • ,
  • Friedhelm Hummel, MD

      Affiliations

    • Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    • Department of Neurology, Hamburg University Medical Center, Hamburg, Germany.
    • ,
  • Michelle Harris-Love, PhD

      Affiliations

    • Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    • ,
  • Rebecca Wolk, BA

      Affiliations

    • Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    • ,
  • Leonardo G. Cohen, MD

      Affiliations

    • Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    • Corresponding Author InformationRequest reprints to Leonardo G. Cohen, MD, Human Cortical Physiology Section, NINDS, NIH, Bethesda, MD 20817

Abstract 

Celnik P, Hummel F, Harris-Love M, Wolk R, Cohen LG. Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke.

Objective

To test the hypothesis that somatosensory stimulation would enhance the effects of training functional hand tasks immediately after practice and 1 day later in chronic subcortical stroke patients.

Design

Single-blinded and randomized, crossover study.

Setting

Human research laboratory.

Participants

Nine chronic subcortical stroke patients.

Interventions

Three separate sessions of motor training preceded by (1) synchronous peripheral nerve stimulation (PNS), (2) no stimulation, or (3) asynchronous PNS.

Main Outcome Measures

Time to complete the Jebsen-Taylor Hand Function Test (JTHFT time) and corticomotor excitability tested with transcranial magnetic stimulation.

Results

After familiarization practice, during which all patients reached a performance plateau, training under the effects of PNS reduced JTHFT time by 10% beyond the post-familiarization plateau. This behavioral gain was accompanied by a specific reduction in GABAergically mediated intracortical inhibition in the motor cortex. These findings were not observed after similar practice under the influence of no stimulation or asynchronous PNS sessions.

Conclusions

Somatosensory stimulation may enhance the training of functional hand tasks in patients with chronic stroke, possibly through modulation of intracortical GABAergic pathways.

Key Words: Electric stimulation, Motor skills, Rehabilitation, Stroke

 

 Supported by the Intramural Research Program of the National Institute of Neurological Disorders and Stroke, National Institutes of Health; the Rehabilitation Medicine Scientist Training Program (grant no. 5K12HD001097); and the A. v. Humboldt Foundation (Feodor-Lynen grant).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(07)01338-X

doi:10.1016/j.apmr.2007.08.001

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 11 , Pages 1369-1376, November 2007

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