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Título

COMPARISON BETWEEN EFFECTS OF REPETITIVE PERIPHERAL NERVE STIMULATION ON UPPER LIMB MOTOR PERFORMANCE IN THE SUBACUTE AND CHRONIC PHASES AFTER STROKE

Resumo

INTRODUCTION: Repetitive peripheral nerve stimulation (RPNS) is a promising neuromodulation intervention to improve upper limb motor performance in stroke. Stimulation intensities higher than the sensory threshold (suprasensory) were associated with benefits compared to stimulation intensities below the sensory threshold (subsensory) or no stimulation, in patients in the chronic phase after stroke. There is limited information about the effects of different intensities of RPNS, early after stroke. OBJECTIVE: To compare the effects of suprasensory and subsensory RPNS of the median nerve, on performance of the paretic upper limb in the subacute (< 6 months) and chronic (> 6 months) phases after stroke. METHODS: This is an ongoing, multicenter, randomized, parallel-group, proof-of principle clinical trial with blinded assessment of outcomes. Patients are randomized to 2-hour suprasensory or subsensory RPNS in the subacute (Groupsuprasubac and Groupsubsubac) or chronic phases (Groupsuprachronic and Groupsubchronic) after stroke. In all groups, motor training is performed after RPNS. The primary outcome is the improvement in performance in the Jebsen-Taylor Test (JTT), assessed before and after RPNS, as well as after training. Descriptive analyses of the preliminary results are shown. Statistical tests to compare differences within and across groups will only be performed at the end of the study. PRELIMINARY RESULTS: Until March 2022, 39 of 72 volunteers were included. At baseline, motor performance was similar in Groupsuprasubac (n=7) and Groupsubsubac (n=8), but worse in Groupsubchronic (n=7) than in Groupsuprachronic (n=13) . Improvement in JTT scores occurred in 28.5% of the patients in Groupsuprasubac, 75% of the Groupsubsubac,, 61.7% of the Groupsuprachronic , and 57.1% of the Groupsubchronic. After training, performance improved in all patients. Changes in performance after stimulation were (in seconds, average ± standard deviation; positive values indicate better performance): -18.4±35.3, Groupsuprasubac; 8.5±8.5, Groupsubsubac; 4.8±11.3, Groupsuprachronic; 5.5±16, Groupsubchronic. Improvements in performance after training were: 3.5±24.5, Groupsuprasubac; 19.7±12.7, Groupsubsubac; 17.9±11.6, Groupsuprachronic; 23.7±16.0, Groupsubchronic. CONCLUSION: Although preliminary, these results suggest that suprasensory RPNS may be beneficial to patients in the chronic, but not in the subacute phase after stroke. The study is currently recruiting patients.

Palavras Chave

stroke; upper limb; peripheral nerve stimulation