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Cortical versus afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury [with consumer summary]
Gomes-Osman J, Field-Fote EC
Clinical Rehabilitation 2015 Aug;29(8):771-782
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; 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*

OBJECTIVE: To assess single-session effects of three different types of stimuli known to increase cortical excitability when combined with functional task practice. DESIGN: Randomized cross-over trial. PARTICIPANTS: A total of 24 participants with chronic cervical spinal cord injury. INTERVENTIONS: One 30-minute session of each, applied concurrently with functional task practice: transcranial direct current stimulation, vibration, and transcutaneous electrical nerve stimulation. MEASUREMENTS: Nine-hole Peg Test, pinch force, visuomotor tracking, and cortical excitability were collected at pretest, posttest and late posttest (30 minutes after). Early effects (posttest minus pretest) and short-term persistence (late posttest minus pretest) were assessed using a general linear mixed model. Magnitude of effect size was assessed using the Cohen's d. RESULTS: Transcutaneous electrical nerve stimulation was associated with moderate, significant early effects and short-term persistence on Nine-hole Peg Test performance (1.8 +/- 1.8, p = 0.003, d = 0.59; 2.0 +/- 2.5, p < 0.001, Cohen's d = 0.65, respectively). Transcranial direct current stimulation (1.8 +/- 2.5, p = 0.003, Cohen's d = 0.52) was also associated with significant short-term persistence of moderate size on Nine-hole Peg Test performance (1.8 +/- 2.5, p = 0.003, Cohen's d = 0.52) and visuomotor tracking performance (p = 0.05, d = 0.51). Early effects on corticomotor excitability were significant for transcutaneous electrical nerve stimulation (p = 0.003), approached significance for transcranial direct current stimulation (p = 0.07), and only vibration was associated with significant short-term persistence (p = 0.006). CONCLUSIONS: Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.

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