Sensory Stimulation Augments the Effects of Massed Practice Training in Persons With Tetraplegia
Preliminary results of this study were presented to the American Paraplegia Society, September 2005, in Las Vegas, NV.
Abstract
Beekhuizen KS, Field-Fote EC. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia.
Objective
To compare functional changes and cortical neuroplasticity associated with hand and upper extremity use after massed (repetitive task-oriented practice) training, somatosensory stimulation, massed practice training combined with somatosensory stimulation, or no intervention, in persons with chronic incomplete tetraplegia.
Design
Participants were randomly assigned to 1 of 4 groups: massed practice training combined with somatosensory peripheral nerve stimulation (MP+SS), somatosensory peripheral nerve stimulation only (SS), massed practice training only (MP), and no intervention (control).
Setting
University medical school setting.
Participants
Twenty-four subjects with chronic incomplete tetraplegia.
Interventions
Intervention sessions were 2 hours per session, 5 days a week for 3 weeks. Massed practice training consisted of repetitive practice of functional tasks requiring skilled hand and upper-extremity use. Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold.
Main Outcome Measures
Pre- and post-testing assessed changes in functional hand use (Jebsen-Taylor Hand Function Test), functional upper-extremity use (Wolf Motor Function Test), pinch grip strength (key pinch force), sensory function (monofilament testing), and changes in cortical excitation (motor evoked potential threshold).
Results
The 3 groups showed significant improvements in hand function after training. The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group, but only the MP+SS group had a significant change in sensory scores compared with the control group. The MP+SS and MP groups had greater change in threshold measures of cortical excitability.
Conclusions
People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills. Somatosensory stimulation appears to be a valuable adjunct to training programs designed to improve hand and upper-extremity function in these subjects.
aThe Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
bDepartment of Veterans Affairs Medical Center, Miami, FL
cDepartment of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL
dDepartment of Physical Therapy, Nova Southeastern University, Ft. Lauderdale, FL.
Reprint requests to Edelle C. Field-Fote, PhD, PT, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 1095 NW 14 Ter (R-48), Miami, FL 33136.
Supported by The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, and the Department of Veterans Affairs Medical Center, Miami, FL.
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.
ABSTRACT