Sensory Stimulation Augments the Effects of Massed Practice Training in Persons With Tetraplegia

• Published in: Archives of physical medicine and rehabilitation Vol. 89; no. 4; pp. 602 - 608
• Main Authors: Beekhuizen, Kristina S., Field-Fote, Edelle C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2008; Elsevier
• Subjects: Adult; Aged; Analysis of Variance; Biological and medical sciences; Diseases of the osteoarticular system; Electric Stimulation Therapy - methods; Evoked Potentials, Motor; Female; Follow-Up Studies; Hand; Hand Strength - physiology; Humans; Injury Severity Score; Logistic Models; Male; Medical sciences; Middle Aged; Miscellaneous; Motor skills; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuronal plasticity; Physical Medicine and Rehabilitation; Probability; Quadriplegia - diagnosis; Quadriplegia - rehabilitation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recovery of Function; Reference Values; Rehabilitation; Risk Assessment; Somatosensory Cortex - physiology; Spinal cord injuries; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - rehabilitation; Time Factors; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Upper Extremity; Spinal cord injuries; Neuronal plasticity; Rehabilitation; Hand; Motor skills; Peripheral nerve; Muscle strength; Prognosis; Motor system disorder; Reeducation; Spinal cord trauma; Median nerve; Upper limb; Neurological disorder; Human; Gripping; Tetraplegia; Nervous system diseases; Intensity; Upper extremity; Pinching; Chronic; Hand function; Orthopedics; Central nervous system disease; Motor evoked potential; Spinal cord disease; Strength
• ISSN: 0003-9993; 1532-821X; 1532-821X
• DOI: 10.1016/j.apmr.2007.11.021

Beekhuizen KS, Field-Fote EC. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia. To compare functional changes and cortical neuroplasticity associated with hand and upper extremity use after massed (repetitive task-oriented practice) training, somatosensory stimulation, massed practice training combined with somatosensory stimulation, or no intervention, in persons with chronic incomplete tetraplegia. Participants were randomly assigned to 1 of 4 groups: massed practice training combined with somatosensory peripheral nerve stimulation (MP+SS), somatosensory peripheral nerve stimulation only (SS), massed practice training only (MP), and no intervention (control). University medical school setting. Twenty-four subjects with chronic incomplete tetraplegia. Intervention sessions were 2 hours per session, 5 days a week for 3 weeks. Massed practice training consisted of repetitive practice of functional tasks requiring skilled hand and upper-extremity use. Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold. Pre- and post-testing assessed changes in functional hand use (Jebsen-Taylor Hand Function Test), functional upper-extremity use (Wolf Motor Function Test), pinch grip strength (key pinch force), sensory function (monofilament testing), and changes in cortical excitation (motor evoked potential threshold). The 3 groups showed significant improvements in hand function after training. The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group, but only the MP+SS group had a significant change in sensory scores compared with the control group. The MP+SS and MP groups had greater change in threshold measures of cortical excitability. People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills. Somatosensory stimulation appears to be a valuable adjunct to training programs designed to improve hand and upper-extremity function in these subjects.