[ARTICLE] Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial

Abstract

Objective: To assess the effects of additional electrical stimulation to hand muscles combined with repetitive task practice therapy on skilled hand performance in stroke patients.

Design: A randomized controlled study.

Setting: Neurological physical therapy outpatient clinic.

Subjects: Forty stroke patients of both sexes (45-65 years – 16 females and 24 males).

Methods: Participants were randomly assigned into two equal groups: experimental and control groups. All patients received repetitive task practice. Those in the experimental group received additional electrical stimulation for specific hand muscles and patients in the control group received sham electrical stimulation. Treatment was provided three times/week for two months.

Main outcome measures: Patients received baseline and post-treatment assessments using three-dimensional motion analysis (to evaluate range of motion of fingers abduction and extension), motor assessment scale (to assess hand motor function) and time to complete Jebsen Taylor Test (to assess hand skills).

Results: Patients in the experimental group showed a significant improvement as compared with those in the control group. Motor assessment scale score was 4.25±0.63 for the experimental group and 3.35±0.74 for the control group (t=-3.50 and p= 0.0001). Time to complete Jebsen Taylor Test was 180.90±7.04 for the experimental group and 192.80±6.87 for the control group (t=4.50 and p= 0.0001). There was a significant improvement in fingers abduction and extension in both groups (in favor to the experimental group).

Conclusion: Repetitive task practice therapy combined with electrical stimulation can improve skilled hand performance in terms of hand motor function, skills and range of motion in stroke patients.

Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial.

[ARTICLE] Transcranial Direct Current Stimulation to Primary Motor Area Improves Hand Dexterity and Selective Attention in Chronic Stroke

Abstract

Objective: The aim of this study was to determine whether transcranial direct current stimulation (tDCS) applied to the primary motor hand area modulates hand dexterity and selective attention after stroke.

Design: This study was a double-blind, placebo-controlled, randomized crossover trial involving subjects with chronic stroke. Ten stroke survivors with some pinch strength in the paretic hand received three different tDCS interventions assigned in random order in separate sessions—anodal tDCS targeting the primary motor area of the lesioned hemisphere (M1_lesioned), cathodal tDCS applied to the contralateral hemisphere (M1_nonlesioned), and sham tDCS—each for 20 mins. The primary outcome measures were Purdue pegboard test scores for hand dexterity and response time in the color-word Stroop test for selective attention. Pinch strength of the paretic hand was the secondary outcome.

Results: Cathodal tDCS to M1_nonlesioned significantly improved affected hand dexterity (by 1.1 points on the Purdue pegboard unimanual test, P = 0.014) and selective attention (0.6 secs faster response time on the level 3 Stroop interference test for response inhibition, P = 0.017), but not pinch strength. The outcomes were not improved with anodal tDCS to M1_lesioned or sham tDCS.

Conclusions: Twenty minutes of cathodal tDCS to M1_nonlesioned can promote both paretic hand dexterity and selective attention in people with chronic stroke.

μέσω Transcranial Direct Current Stimulation to Primary Motor Are… : American Journal of Physical Medicine & Rehabilitation.