Article

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. 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 constraint-induced therapy
more than sham peripheral nerve stimulation (significance at P < 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 constraint-induced 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. 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 reader should be able to: (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; and (3) Understand the rationale for applying
an adjuvant intervention to optimize outcomes of constraint-based therapy
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 activity for a maximum of 1.5 AMA PRA
Category 1 Credit(s). Physicians should only claim credit commensurate with the
extent of their participation in the activity.

Langue : ANGLAIS