One-hour peripheral electrical stimulation modulates corticomotor excitability and hand dexterity in people with chronic stroke

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237

Methods: This was a multi-centered, randomized controlled study that enrolled preterm infants with VLBW from three medical centers in northern and southern Taiwan. The FCIP group infants received 5-session in-hospital intervention and 7-session after-discharge intervention until 12 months of corrected age; whereas the usual care program (UCP) group infants received 5-session in-hospital intervention and 7-session after-discharge phone calls scheduled at the same time as those of the FCIP. The FCIP contained parent- and child-focused services; whereas the UCP contained child-focused services mainly. Outcome measurements included morbidity, growth and neurobehavioral performance at term-equivalent age. Results: This study included 262 VLBW preterm infants (127 in the FCIP and 135 in the UCP). The two groups were similar in perinatal and demographic characteristics. The FCIP group infants required a shorter duration of hospital stay (56.1 ± 24 days vs. 62.5 ± 24.7 days), achieved greater daily weight gains from birth to term age (26.8 ± 7 g vs. 24.7 ± 7.4 g) and from 36 weeks’ postmenstrual age to term age (39.5 ± 14.1 g vs. 35 ± 15.3 g), and exhibited higher neurobehavioral total scores (71.6 ± 4.6 vs.70.1 ± 4.1) and muscle tone and motor pattern score (23.9 ± 1.9 vs.23. ± 2.1) (all p < 0.05). Conclusion(s): The FCIP yielded short-term benefit in shortening the length of hospital stay and enhancing growth and neurobehavioral performance in VLBW preterm infants during the neonatal period. A continued follow-up of these infants is currently underway to examine the long-term effectiveness. Implications: The results provided important information for the design of intervention program and assessment of intervention effect in VLBW preterm infants. Keywords: Effectiveness; Family-centered intervention; Preterm infants Funding acknowledgements: This study was supported by a grant from the National Health Research Institute (NHRI-EX101-10106PI) in Taiwan. Ethics approval: This study has been approved by the Research Ethics Committee of the study hospitals (Clinical Trial Registration Number: NCT01807533, http://www.clinicaltrials.gov). http://dx.doi.org/10.1016/j.physio.2015.03.1730

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Research Report Poster Presentation Number: RR-PO-99-05-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 ONE-HOUR PERIPHERAL ELECTRICAL STIMULATION MODULATES CORTICOMOTOR EXCITABILITY AND HAND DEXTERITY IN PEOPLE WITH CHRONIC STROKE H. Liu 1,2 , S.S.Y. Au-Yeung 1 1 The

Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, China; 2 Guangdong Provincal work Injury Rehabilitation Hospital, Department of Physical Therapy, Guangzhou, China Background: Electrical peripheral nerve stimulation (PNS) to the paretic limb combined with task training has been shown to induce the change in corticomotor excitability in lesioned hemisphere and improve the paretic hand function in people with stroke. It is not yet clear whether PNS alone would modulate corticomotor activities in the lesioned hemisphere after stroke, and whether such neuromodulation would be associated with hand motor function changes. Purpose: To examine changes in corticomotor excitability in lesioned hemisphere after PNS to the paretic upper limb and their relationship with hand function in people in their chronic stage stroke. Methods: In this single-blinded randomised cross-over study, 32 subjects after stroke (mean age: 60.5 ± 7.8 years; time since stroke: 6.8 ± 3.5 years) with mild to moderate upper limb function impairment (Fugl-Meyer Assessment score: 58.4 ± 8.9; Action Research Arm Test score: 48.8 ± 12.1) received two sessions of either PNS or placebo-PNS to the paretic hand for 1 hour arranged in random order. Electrical current of pulse duration of 450 ␮s delivered at 50 Hz modulated with 10 Hz, was applied simultaneously to the radial and ulnar nerve in the paretic arm. The current intensity in PNS session was set to elicit twitches of the hand muscles without causing discomfort or pain. For the session of placebo-PNS, the current intensity was set at the lowest level provided by the stimulator unit for the whole hour. The outcome measurements included corticomotor excitability in lesioned hemisphere for the contralateral first dorsal interosseous hand muscle were evaluated with transcranial magnetic stimulation on 4 domains - resting motor threshold, recruitment curve slope, peak motor evoked potential (pMEP) amplitude and duration of the cortical silent period (CSP). Motor functions in the paretic hand in terms of pinch strength and the Purdue pegboard dexterity score were also assessed before and after the PNS or placebo stimulation. Results: PNS but not placebo-PNS increased the recruitment curve slope and pMEP amplitude in corticomotor excitability of the FDI in lesioned hemisphere (p ≤ 0.003). The Purdue dexterity score (p = 0.028) was higher, with the

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237

percent improvement correlated with the change in CSP (Pearson r = 0.52) but not other corticomotor excitability outcomes. Pinch strength was not improved. Conclusion(s): One-hour PNS to the paretic arm can increase corticomotor excitability in the lesioned hemisphere in people with chronic stroke. The percent change in intracortical inhibitory synaptic activity is related to the extent of hand dexterity improvement. Implications: These results promote the understanding of the neurophysiological mechanism underlying PNS. The effects of repeated sessions of PNS on dexterity function in the paretic hand should be further investigated to inform evidence-based intervention for people whose recovery has become plateau in chronic stroke. Keywords: Stroke 2; Peripheral nerve stimulation; Corticomotor excitability Funding acknowledgements: This work was supported by a PhD research studentship provided to Mr H LIU by the Hong Kong Polytechnic University. Ethics approval: Ethical approval obtained from the Human Subjects Ethics Subcommittee of the Hong Kong Polytechnic University. http://dx.doi.org/10.1016/j.physio.2015.03.1731 Research Report Poster Presentation Number: RR-PO-99-06-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 EFFECTS OF COGNITIVE AND MOTOR DUAL TASK TRAINING ON GAIT PERFORMANCE IN INDIVIDUALS WITH STROKE—A PILOT STUDY Y.C. Liu, R.Y. Wang, Y.R. Yang National Yang-Ming University, Department of Physical Therapy and Assistive Technology, Taipei, Taiwan Background: Mobility in daily life requires walking while performing simultaneously cognitive or motor tasks (dual tasking). In the past few years, researches pointed out dual tasking may deteriorate gait performance especially in stroke subjects. However, it is not immediately known about the effects of different types of dual task gait training in stroke. Purpose: The aim of present study was to investigate the effects of cognitive and motor dual task gait training on gait performance in individuals with stroke. Methods: This was a randomized controlled trial with pre- and post-measurements. Participants were randomized to one of the 3 groups, the control group, cognitive dual task group and motor dual task group. Subjects in control group received regular physical therapy. Participants in cognitive or motor dual task group practiced the cognitive or motor tasks respectively during walking forward, backward and S shape route. The intervention was 30 min per session, 3 sessions

per week for a total of 4 weeks. The outcomes included gait performance, the speed, cadence, step length, stride time, gait symmetry and dual task cost (DTC) measured by GAITRite system. The one-way ANOVA and chi-square test was used for basic data analysis. Paired t test is used for intra-group difference. To analyze intergroup improvement, the change values were analyzed using one-way ANOVA with Tukey post-hoc test. The statistical significance was set at p < .05. Results: Twenty-five subjects with stroke with at least limited community ambulatory ability (a minimum gait velocity, 58 cm/s) participated in this study. The cadence was significantly increased and stride time was significantly decreased during cognitive dual task walking after cognitive dual task gait training than the regular or motor dual task training. Furthermore, the stride length and DTC during cognitive dual task walking was improved after the cognitive dual task training. However, after motor dual task training, the increase in stride length during cognitive dual task walking, increased in speed, stride length, and decreased DTC during motor dual task walking, decreased in cadence and increase in stride time and stride length during regular walking were noted. After the regular training, improvements in gait speed, cadence, and stride length while performing motor dual task walking were also noted. Conclusion(s): The cognitive dual task gait training seems to exert better effect on cognitive dual task gait performance than regular or motor dual task training. The motor dual task training can improve gait performance during different conditions. Implications: The cognitive and motor dual task training can be adopted as the training strategy in stroke rehabilitation to improve gait performance in different conditions. Keywords: Dual task training; Gait performance; Stroke Funding acknowledgements: MOST-103-2314-B-010002-MY3. Ethics approval: The study protocol was approved by the Institutional Review Board of Taipei Veterans General Hospital (No. 2013-08-017A). http://dx.doi.org/10.1016/j.physio.2015.03.1732