Effects of Somatosensory Stimulation on Use-Dependent Plasticity in Chronic Stroke

Sawaki, Lumy; Wu, Chin H.; Kaelin‐Lang, Alain; Cohen, Leonardo G.

doi:10.1161/01.str.0000195130.16843.ac

Cited by 118 publications

(97 citation statements)

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“…19,20 This relative inability of 30 minutes training to elicit the desired effect on motor memory formation represents an excellent model against which to compare various strategies designed to boost training effects. It has been shown that dopaminergic agents could enhance training effects on motor memory formation in older adults 21 and in patients with stroke.…”

Section: Discussionmentioning

confidence: 99%

Effects of Action Observation on Physical Training After Stroke

Celnik

Webster

Glasser

et al. 2008

Stroke

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201

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Background and Purpose-In healthy humans, observation of another individual performing a motor training task (action observation [AO]) facilitates, in the observer, the effects of physical training (PT) on motor memory formation. It is not known whether this facilitatory process, of potential value for neurorehabilitation, occurs after stroke. Methods-Eight chronic stroke patients completed this crossover-randomized investigation. A transcranial magnetic stimulation protocol that tests formation of motor memories was used to determine the effects of PT alone and in combination with AO in 2 different forms: congruent (PTϩAO congruent ) and incongruent (PTϩAO incongruent ) to the practiced task. Results-The magnitude of motor memory formation was larger with PTϩAO congruent than with PT alone or PTϩ AO incongruent . This effect was associated with a differential corticomotor excitability change in the muscles acting as agonist and antagonist of the trained/observed movements. Conclusions-These

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Section: Discussionmentioning

confidence: 99%

Effects of Action Observation on Physical Training After Stroke

Celnik

Webster

Glasser

et al. 2008

Stroke

Self Cite

201

158

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“…In a series of experiments, 2 hours of sensory stimulation increased the degree of plasticity. 21 The most extensively studied sensorystimulating drug by far is dextro-amphetamine. 22 In chronic stroke patients after 30 minutes of training, there was an increase not only in training-dependent plasticity but also in acceleration in the development of training-dependent plasticity when dextro-amphetamine was administered.…”

Section: Learning That Is Relevant To Recoverymentioning

confidence: 99%

Functional Restoration for the Stroke Survivor: Informing the Efforts of Engineers

Patton

Small

Rymer

2008

Topics in Stroke Rehabilitation

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As bioengineers begin to notice the importance of therapy in the recovery from stroke and other brain injuries, new technologies will be increasingly conceived, adapted, and designed to improve the patient's road to recovery. What is clear from engineering history, however, is that the best engineering efforts are often built on strong scientific foundations. In an effort to inform engineers with the necessary background on cutting edge research in the field of stroke and motor recovery, this article summarizes the views of several experts in the field as a result of a workshop held in 2006 on the topic. Here we elaborate on several areas relevant to this goal, including the pathophysiology of stroke and stroke recovery, the biomechanics, the secondary peripheral changes in muscle and other tissue, and the results of neuroimaging studies. One conclusion is that the current state of knowledge is now ripe for research using machines but that highly sophisticated robotic devices may not yet be needed. Instead, what may be needed is basic evidence that shows a difference in one therapeutic strategy over another. KeywordsCVA; control; movement; muscle; rehabilitation human; stroke There has been considerable attention in recent years to the natural course of recovery from stroke and to the effects of therapeutic intervention. This should not come as a great surprise, because stroke is by far the leading cause of physical disability among adults in the United States, with annual rehabilitation costs in the billions. The prevalence of stroke is enormous. According to the American Heart Association, the number of stroke survivors increased from 1.5 million in the early 1970s to 2.4 million by the early 1990s, 1 to over 3 million today. This increase goes hand in hand with the aging of our population. Currently, the population of those 65 years or older is approximately 33+ million (12.7% of US population in 1999) and is projected to be 53 million by 2020 and 77 million by 2040 (see www.strokeassociation.org). The percentage of Americans 45-54 years old living with stroke is under 2%; it is almost 4% in those 55-64 years old, rises to 6% for those 65-74, and rises to more than 10% for those 75 and over. 2 Clearly, the issues related to the long-term treatment of stroke will be increasingly important societal issues.Furthermore, although the incidence of stroke is falling overall, presumably because of the improvement in medical management of hypertension, hyperlipidemia, and vascular disease, NIH Public Access

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“…8,9 During performance of motor tasks, repetitive activation of sensory input enhances motor cortical plasticity, establishing a mechanism for the role of sensory input in motor skill acquisition. [10][11][12] A sensory-based intervention called peripheral nerve stimulation (PNS) has been shown to increase motor cortical excitability and enhance outcomes of motor training after stroke. In a study of 22 subjects <6 months after stroke, PNS paired with 1 week of intensive task-oriented UE training was associated with more significant improvement in movement function than the effects of training alone as measured by the Wolf Motor Function Test (WMFT).…”

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confidence: 99%

“…In a study of 22 subjects <6 months after stroke, PNS paired with 1 week of intensive task-oriented UE training was associated with more significant improvement in movement function than the effects of training alone as measured by the Wolf Motor Function Test (WMFT). 13 A separate study by Sawaki et al 12 investigated the effects of PNS on voluntary movement of paretic thumb in 7 subjects at least 6 months post stroke. Significantly more neuroplastic change was associated with active PNS compared with sham conditions.…”

mentioning

confidence: 99%

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke

Carrico

Chelette

Westgate

et al. 2016

Stroke

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Background and Purpose-A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement). Methods-Subjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up. Results-Statistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, −0.21 to −0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on ≥1 outcomes at ≥1 time points after intervention. Conclusions-After stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed. Corroborating evidence from a systematic review of randomized and quasi-randomized trials indicated that motor recovery after stroke may be enhanced with PNS, especially when PNS is delivered as an adjunct to motor training. 13,14A well-validated form of motor training called intensive task-oriented training has been associated with significant neuroplastic change, as well as more significant functional gains than usual and customary care, in cases of mild-to-moderate hemiparesis. 15 Further research is needed to optimize intensive task-oriented training for people with severely impaired movement function after stroke. 7 In addition, randomized controlled trials showing that PNS can enhance outcomes of task-oriented training have primarily targeted only mild-to-moderate UE impairment. [16][17][18][19] In sum, although pairing PNS with motor training can enhance motor recovery after stroke, it remains unclear how severity of motor deficit may affect responsiveness to this paired intervention.14 To address these evidence gaps, the purpose of this study was to investigate whether active PNS paired with intensive task-oriented training would lead to significantly more improved movement function than sham PNS paired with intensive ta...

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Effects of Somatosensory Stimulation on Use-Dependent Plasticity in Chronic Stroke

Cited by 118 publications

References 12 publications

Effects of Action Observation on Physical Training After Stroke

Effects of Action Observation on Physical Training After Stroke

Functional Restoration for the Stroke Survivor: Informing the Efforts of Engineers

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke

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