on March 12, 2009
Published online before print March 12, 2009, doi: 10.1161/STROKEAHA.108.540500
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Submitted on October 20, 2008
From the Human Cortical Physiology and Stroke Neurorehabilitation Section (P.C., N.-J.P., Y.V., M.D., L.G.C.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; the Department of Physical Medicine and Rehabilitation (P.C.), Johns Hopkins University, Baltimore, Md; the Department of Rehabilitation Medicine (N.-J.P.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea; and the Department of Neurology (Y.V.), Cliniques Universitaires UCL de Mont-Godinne, Université Catholique de Louvain, Belgium. * To whom correspondence should be addressed. E-mail: pcelnik{at}jhmi.edu.
Background and Purpose—Recent work demonstrated that application of peripheral nerve and cortical stimulation independently can induce modest improvements in motor performance in patients with stroke. The purpose of this study was to test the hypothesis that combining peripheral nerve stimulation (PNS) to the paretic hand with anodal direct current stimulation (tDCS) to the ipsilesional primary motor cortex (M1) would facilitate beneficial effects of motor training more than each intervention alone or sham (tDCSSham and PNSSham). Methods—Nine chronic stroke patients completed a blinded crossover designed study. In separate sessions, we investigated the effects of single applications of PNS+tDCS, PNS+tDCSSham, tDCS+PNSSham, and PNSSham+tDCSSham before motor training on the ability to perform finger motor sequences with the paretic hand. Results—PNS+tDCS resulted in a 41.3% improvement in the number of correct key presses relative to PNSSham+tDCSSham, 15.4% relative to PNS+tDCSSham, and 22.7% relative to tDCS+PNSSham. These performance differences were maintained 1 and 6 days after the end of the training. Conclusions—These results indicate that combining PNS with tDCS can facilitate the beneficial effects of training on motor performance beyond levels reached with each intervention alone, a finding of relevance for the neurorehabilitation of motor impairments after stroke.
Revised on November 7, 2008
Accepted on November 12, 2008
Effects of Combined Peripheral Nerve Stimulation and Brain Polarization on Performance of a Motor Sequence Task After Chronic Stroke
Pablo Celnik MD*;
Key words: stroke • rehabilitation • transcranial direct current stimulation • nerve stimulation
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