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Randomized trial of peripheral nerve stimulation to enhance modified constraint-induced therapy after stroke
Carrico C, Chelette KC II, Westgate PM, Salmon-Powell E, Nichols L, Sawaki L
American Journal of Physical Medicine & Rehabilitation 2016 Jun;95(6):397-406
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: Yes; Blind therapists: Yes; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Constraint-based therapy and peripheral nerve stimulation can significantly enhance movement function after stroke. No studies have investigated combining these interventions for cases of chronic, mild-to-moderate hemiparesis following stroke. OBJECTIVE: This study aims to determine the effects of peripheral nerve stimulation paired with a modified form of constraint-induced therapy on upper extremity movement function after stroke. Nineteen adult stroke survivors with mild-to-moderate hemiparesis more than 12 mo after stroke received 2 hours of either active (n = 10) or sham (n = 9) peripheral nerve stimulation preceding 4 hours of modified constraint-induced therapy (10 sessions). RESULTS: Active peripheral nerve stimulation enhanced modified constraint-induced therapy more than sham peripheral nerve stimulation (significance at p < 0.05), both immediately after intervention (Wolf Motor Function Test p = 0.006 (timed score); p = 0.001 (lift score); Fugl-Meyer Assessment p = 0.022; Action Research Arm Test p = 0.007) and at 1-mo follow-up (Wolf Motor Function Test p = 0.025 (timed score); p = 0.007 (lift score); Fugl-Meyer Assessment p = 0.056; Action Research Arm Test p = 0.028). CONCLUSION: Pairing peripheral nerve stimulation with modified constraint-induced therapy can lead to significantly more improvement in upper extremity movement function than modified constraint-induced therapy alone. Future research is recommended to help establish longitudinal effects of this paired intervention, particularly as it affects movement function and daily life participation.

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