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June 2016 CME Article No. 6: Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke
Additional Information
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 constraintinduced therapy more than sham peripheral nerve stimulation (significance at P G 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 constraintinduced 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.

Learning Objectives:
  1. Understand the role that afferent input plays with regard to movement function
  2. Understand general concepts of delivering modified constraint-based therapy in stroke rehabilitation research
  3. Understand the rationale for applying an adjuvant intervention to optimize outcomes of constraint-based therapy following stroke
Summary
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