Article

This study aimed to examine the corticomotor excitability changes
after peripheral nerve electrical stimulation (PNS) on the stroke-impaired arm.
DESIGN: This randomized cross-over study included 32 subjects with chronic
stroke. They received a 1-hr PNS or placebo PNS by random order to the ulnar and
radial nerves of the paretic arm in separate sessions.
The primary outcome was
excitability of the corticospinal projections for the contralateral first dorsal
interosseous hand muscle in terms of slope of the recruitment curve, peak
motor-evoked potential amplitude, and duration of the cortical silent period,
measured with transcranial magnetic stimulation on both cerebral hemispheres.
Seventeen of the subjects were measured for their paretic hand dexterity (using
Purdue Pegboard Test) and pinch strength as secondary outcomes. RESULTS:
Peripheral nerve electrical stimulation, but not placebo PNS, increased
recruitment curve slope and peak motor-evoked potential amplitude in both the
lesioned and nonlesioned hemispheres and lengthened the cortical silent period
duration in the nonlesioned hemisphere. Peripheral nerve electrical stimulation
significantly improved hand dexterity scores compared with placebo PNS. Pinch
strength was not changed by the interventions. CONCLUSIONS: A 1-hr PNS alone to
the paretic arm could increase corticomotor excitability in both hemispheres,
together with hand dexterity improvement in people presented with
mild-to-moderate motor impairment in the paretic upper limb after stroke. TO
CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at
http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this
article, the readers should be able to: (1) Understand the effects of a stroke on
the corticomotor excitability of the lesioned and intact hemisphere; (2) Describe
the effect of peripheral nerve electrical stimulation on the lesioned and intact
hemisphere corticomotor excitability following stroke; and (3) Understand the
effect of peripheral nerve electrical stimulation on dexterity of the paretic
hand following stroke. LEVEL: Advanced ACCREDITATION: The Association of Academic
Physiatrists is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians.The Association
of Academic Physiatrists designates this Journal-based CME activity for a maximum
of 0.75 AMA PRA Category 1 Credit(s). Physicians should only claim credit
commensurate with the extent of their participation in the activity.

Langue : ANGLAIS