Combined treatments improve arm, hand function in stroke survivors

Constraint-induced therapy and nerve stimulation are more effective when used together, researchers found in a recent study.
By Stephen Feller   |   March 9, 2016 at 8:41 AM

LEXINGTON, Ky., March 9 (UPI) -- The combination of nerve stimulation and constraint-induced therapy is more effective at returning function after a stroke than either alone, according to a recent study.

Both therapies improve movement after a stroke individually, but researchers at the University of Kentucky found participants in the study showed more improvement over time when the two were combined.

Constraint-induced therapy limits the movement of a patient's unaffected hand, usually with a padded glove, forcing use of the partially paralyzed hand. Often, as in the study, patients are asked to wear the glove as much as possible in daily life to increase the treatment's effects.

Peripheral nerve stimulation consists of low-level electrical stimulation applied to nerves in the paralyzed arm, increasing activity in the brain area responsible for controlling the limb.

"It appears that peripheral nerve stimulation has enormous promise as a clinical intervention to enhance outcomes of motor training for stroke survivors with mild to moderate hemiparesis," the researchers said in a press release.

For the study, published in the American Journal of Physical Medicine and Rehabilitation, researchers recruited 19 patients with mild to moderate paralysis of one upper limb at least a year after having a stroke. All participants had CIT, being asked to wear a padded mitt on the less-affected hand during four hours of therapy, as well as for 90 percent of the time they were awake. The participants also were given either active or inactive PNS through electrodes on their arm for two hours before CIT.

Both groups showed improvement after 10 sessions, however those receiving both treatments showed greater improvements to movement on most measures aside from grip strength, which was the same.

At follow-ups a month after treatment, the group that received both treatments continued to show greater improvement in function. The researchers suggest the patients who received active PNS used their affected arm and hand more during daily life, which would help speed recovery.

Further research will need to prove the combination works, as well as to find optimal PNS settings and the best way to combine the treatments for individual patients, they said.

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