Repetitive Nerve Stimulation to Improve Recovery After Stroke

Hospital Israelita Albert Einstein51 enrolled

Overview

Upper limb paresis is the most common type of post-stroke neurological impairment and a major cause of functional disability. Repetitive peripheral sensory stimulation (RPSS) is a novel strategy to improve upper limb motor performance in the post-stroke chronic phase but its effects in the subacute phase are still poorly understood. The objectives of this study are to compare the effects of RPSS on motor performance of the upper limb in the subacute and chronic phases of stroke, and to identify the mechanisms underlying this intervention.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Stroke

Interventions

Suprathreshold repetitive peripheral sensory stimulationDEVICE

Suprathreshold repetitive peripheral sensory stimulation will be applied to the median nerve of the affected forearm with surface electrodes. The stimulator will be set to deliver bursts of 10 Hz stimulation at 50% duty cycle (500 ms on and off). For suprathreshold stimulation, intensities will be set at the highest intensity able to induce sensory paraesthesias without overt muscle contraction or pain, and adjusted if required.

Subthreshold repetitive sensory stimulationDEVICE

Subthreshold repetitive sensory stimulation will be applied to the median nerve of the affected forearm with surface electrodes. The stimulator will be set to deliver bursts of 10 Hz stimulation at 50% duty cycle (500 ms on and off). For subthreshold stimulation, intensities will be set at 10mv - 15mv lower than de lowest intensity able to induce sensory paraesthesias, and adjusted if required.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Ischemic or hemorrhagic stroke confirmed by computed tomography or magnetic resonance imaging, between 7 days - 3 months before enrollment (subacute phase), and at least 6 months (chronic phase). * Ability to perform at least 4 of 7 tasks performed in daily life that is part of the Jebsen-Taylor Test Exclusion Criteria: * Anesthesia of the paretic hand. * Lesions affecting the motor cortex (hand area). * Lesions affecting cerebellum, or cerebellar pathways in the brainstem. * Severe spasticity at the paretic elbow, fist or fingers, defined with a score larger than 3 on the Modified Ashworth Scale. * Neurological diseases such as Parkinson disease or chronic uncontrolled chronic disease such as cancer or cardiac insufficiency. * Elbow pain or join deformity in the paretic limb. * Pregnancy. * Uncontrolled psychiatric disease. * Aphasia or severe cognitive deficit. * Inability to provide consent. * Inability to attend the experimental sessions.

Locations (1)

Hospital São Rafael

Salvador, Estado de Bahia, Brazil