Combining peripheral nerve stimulation (PNS) with constraint-induced therapy (CIT) may help stroke patients recover movement in the affected arm and hand—even more than 1 year after a stroke—according to recent research.
A media release from Wolters Kluwer Health defines CIT as an approach that forces “intensive, task-oriented use” of the affected hand, by limiting movement of the less-affected hand and forcing patients to use the impaired hand. PNS consists of noninvasive, low-level electric stimulation applied to the nerves of the paralyzed arm muscles, which in turn increases activity in the brain area that controls the arm.
Both therapies take advantage of the brain’s potential to reorganize or “rewire” itself after an injury, per the release.
The study investigating this combination therapy was led by Lumy Sawaki, MD, PhD, and a research team at the University of Kentucky, Lexington, and published in the American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists, published by Wolters Kluwer.
In the study, 19 patients who were left with mild to moderate hemiparesis of one upper limb at least 1 year after experiencing a stroke received a modified CIT approach, including wearing a padded mitt on the less-affected hand during therapy sessions, as well as for 90% of their waking hours outside of therapy.
They also received either active or “sham” (inactive) PNS, delivered through electrodes placed on the affected arm, for 2 hours, followed by 4 hours of CIT.
After 10 sessions, arm and hand function improved for both groups. But on most measures, improvement was significantly greater for patients who received active PNS added to CIT. Grip strength was the only measure to show no significant added advantage with active PNS, the release explains.
Significant differences between the groups persisted to 1-month follow-up.
“Compared with the sham PNS group, the active PNS group may have made more extensive use of the affected upper extremity in settings outside the lab, such as in activities of daily living,” Sawaki and coauthors write, according to the release. They add that further studies are needed to provide conclusive evidence.
[Source(s): Wolters Kluwer Health, EurekAlert]