Background: Individuals with chronic tetraplegia prioritize recovery of hand function as an important factor in improving their quality of life. Interventions that may improve hand function and increase corticomotor excitability are functional electrical stimulation (FES), somatosensory stimulation (SS), and task-oriented training. Objective: We compared functional and corticomotor outcomes in a control condition to changes associated with FES (triggered via electromygraphic signals) and with SS (constant trains), each combined with either unimanual or bimanual training. Methods: Using a randomized, clinical trial design, comparisons were made to a delayed intervention control group. Participants (n = 24) had chronic tetraplegia, with the ability to activate thenar muscles, and were randomly assigned to either the immediate intervention (intervention) or control/ delayed intervention groups. Primary analyses compared intervention (FES or SS) to control/delayed intervention. Secondary analyses compared subgroups of FES versus SS (regardless of uni- or bilateral training) and uni- versus bimanual training (regardless of stimulation type). Outcomes were assessed before and after the control and the intervention period. Results: Compared to control/delayed intervention, the intervention group had greater changes in unimanual function and corticomotor area, regardless of whether practice was combined with FES or with SS. Irrespective of stimulation type, the bimanual subgroups improved to a greater extent than the unimanual subgroups on the bimanual hand function test. Conclusions: Hand training combined with either SS or FES was associated with improved hand use and corticomotor activity in persons with chronic tetraplegia. Both interventions appear to be equally effective.
National Spinal Cord Injury Statistical Center. Annual report for the model spinal cord injury care systems. 2011. https://www.nscisc.uab.edu/PublicDocuments/nscisc_home/pdf/Facts%202011%20Feb%20Final.pdf. Accessed August 13, 2013. https://www.nscisc.uab.edu/PublicDocuments/nscisc_home/pdf/Facts%202011%20Feb%20Final.pdf.
Anderson KD. Targeting recovery: Priorities of the spinal cord-injured population. J Neurotrauma. 2004;21(10):1371–1383.
Targeting recovery: Priorities of the spinal cord-injured population
, J Neurotrauma.
, vol. 21
(pg. 1371
-1383
) Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F. Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 2004;42(9):526–532.
Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics
, Spinal Cord.
, vol. 42
(pg. 526
-532
) Brouwer B, Hopkins-Rosseel DH. Motor cortical mapping of proximal upper extremity muscles following spinal cord injury. Spinal Cord. 1997;35(4):205–212.
Motor cortical mapping of proximal upper extremity muscles following spinal cord injury
, Spinal Cord.
, vol. 35
(pg. 205
-212
) Freund P, Weiskopf N, Ward NS, et al. Disability, atrophy and cortical reorganization following spinal cord injury. Brain. 2011;134(Pt 6):1610–1622.
Disability, atrophy and cortical reorganization following spinal cord injury
, Brain.
, vol. 134
(pg. 1610
-1622
) Davey NJ, Smith HC, Savic G, Maskill DW, Ellaway PH, Frankel HL. Comparison of input-output patterns in the corticospinal system of normal subjects and incomplete spinal cord injured patients. Exp Brain Res.1999;127(4):382–390.
Comparison of input-output patterns in the corticospinal system of normal subjects and incomplete spinal cord injured patients
, Exp Brain Res.
, vol. 127
(pg. 382
-390
) Beekhuizen KS, Field-Fote EC. Massed practice versus massed practice with stimulation: Effects on upper extremity function and cortical plasticity in individuals with incomplete cervical spinal cord injury. Neurorehabil Neural Repair. 2005;19(1):33–45.
Massed practice versus massed practice with stimulation: Effects on upper extremity function and cortical plasticity in individuals with incomplete cervical spinal cord injury
, Neurorehabil Neural Repair.
, vol. 19
(pg. 33
-45
) Beekhuizen KS, Field-Fote EC. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia. Arch Phys Med Rehabil. 2008;89(4):602–608.
Sensory stimulation augments the effects of massed practice training in persons with tetraplegia
, Arch Phys Med Rehabil.
, vol. 89
(pg. 602
-608
) Hoffman LR, Field-Fote EC. Cortical reorganization following bimanual training and somatosensory stimulation in cervical spinal cord injury: A case report. Phys Ther. 2007;87(2):208–223.
Cortical reorganization following bimanual training and somatosensory stimulation in cervical spinal cord injury: A case report
, Phys Ther.
, vol. 87
(pg. 208
-223
) Hoffman LR, Field-Fote EC. Functional and corticomotor changes in individuals with tetraplegia following unimanual or bimanual massed practice training with somatosensory stimulation: A pilot study. J Neurol Phys Ther. 2010;34(4):193–201.
Functional and corticomotor changes in individuals with tetraplegia following unimanual or bimanual massed practice training with somatosensory stimulation: A pilot study
, J Neurol Phys Ther.
, vol. 34
(pg. 193
-201
) Ridding MC, Brouwer B, Miles TS, Pitcher JB, Thompson PD. Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Exp Brain Res. 2000;131(1):135–143.
Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects
, Exp Brain Res.
, vol. 131
(pg. 135
-143
) Panizza M, Nilsson J, Roth BJ, Basser PJ, Hallett M. Relevance of stimulus duration for activation of motor and sensory fibers: Implications for the study of H-reflexes and magnetic stimulation. Electroencephalogr Clin Neurophysiol. 1992;85(1):22–29.
Relevance of stimulus duration for activation of motor and sensory fibers: Implications for the study of H-reflexes and magnetic stimulation
, Electroencephalogr Clin Neurophysiol.
, vol. 85
(pg. 22
-29
) Conforto AB, Cohen LG, dos Santos RL, Scaff M, Marie SKN. Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes. J Neurol. 2007;254(3):333–339.
Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes
, J Neurol.
, vol. 254
(pg. 333
-339
) Cohen LG, Ziemann U, Chen R. Mechanisms, functional relevance and modulation of plasticity in the human central nervous system. Electroencephalogr Clin Neurophysiol. 1999;51(Suppl):174–182.
Mechanisms, functional relevance and modulation of plasticity in the human central nervous system
, Electroencephalogr Clin Neurophysiol.
, vol. 51
(pg. 174
-182
) Popovic MR, Popovic DB, Keller T. Neuroprostheses for grasping. Neurol Res. 2002;24(5):443–452.
Neuroprostheses for grasping
, Neurol Res.
, vol. 24
(pg. 443
-452
) Mangold S, Keller T, Curt A, Dietz V. Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury. Spinal Cord. 2005;43(1):1–13.
Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury
, Spinal Cord.
, vol. 43
(pg. 1
-13
) Popovic MR, Thrasher TA, Adams ME, Takes V, Zivanovic V, Tonack MI. Functional electrical therapy: Retraining grasping in spinal cord injury. Spinal Cord. 2006;44(3):143–151.
Functional electrical therapy: Retraining grasping in spinal cord injury
, Spinal Cord.
, vol. 44
(pg. 143
-151
) Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL. Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: A new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil. 2005;86(8):1616–1622.
Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: A new measure of upper-limb function for survivors of stroke
, Arch Phys Med Rehabil.
, vol. 86
(pg. 1616
-1622
) van Tuijl JH, Janssen-Potten YJM, Seelen HAM. Evaluation of upper extremity motor function tests in tetraplegics. Spinal Cord. 2002;40(2):51–64.
Evaluation of upper extremity motor function tests in tetraplegics
, Spinal Cord.
, vol. 40
(pg. 51
-64
) Halar EM, Hammond MC, LaCava EC, Camann C, Ward J. Sensory perception threshold measurement: An evaluation of semiobjective testing devices. Arch Phys Med Rehabil. 1987;68(8):499–507.
Sensory perception threshold measurement: An evaluation of semiobjective testing devices
, Arch Phys Med Rehabil.
, vol. 68
(pg. 499
-507
) Jerosch-Herold C. Assessment of sensibility after nerve injury and repair: A systematic review of evidence for validity, reliability and responsiveness of tests. J Hand Surg Br. 2005;30(3):252–264.
Assessment of sensibility after nerve injury and repair: A systematic review of evidence for validity, reliability and responsiveness of tests
, J Hand Surg Br.
, vol. 30
(pg. 252
-264
) Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: The health assessment questionnaire, disability and pain scales. J Rheumatol. 1982;9(5):789–793.
The dimensions of health outcomes: The health assessment questionnaire, disability and pain scales
, J Rheumatol.
, vol. 9
(pg. 789
-793
) Darling WG, Wolf SL, Butler AJ. Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation. Exp Brain Res. 2006;174(2):376–385.
Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation
, Exp Brain Res.
, vol. 174
(pg. 376
-385
) Rossini PM, Altamura C, Ferreri F, et al. Neuroimaging experimental studies on brain plasticity in recovery from stroke. Eura Medicophys. 2007;43(2):241–254.
Neuroimaging experimental studies on brain plasticity in recovery from stroke
, Eura Medicophys.
, vol. 43
(pg. 241
-254
) Wassermann EM, McShane LM, Hallett M, Cohen LG. Noninvasive mapping of muscle representations in human motor cortex. Electroencephalogr Clin Neurophysiol. 1992;85(1):1–8.
Noninvasive mapping of muscle representations in human motor cortex
, Electroencephalogr Clin Neurophysiol.
, vol. 85
(pg. 1
-8
) Malcolm MP, Triggs WJ, Light KE, Shechtman O, Khandekar G, Gonzalez Rothi LJ. Reliability of motor cortex transcranial magnetic stimulation in four muscle representations. Clin Neurophysiol. 2006;117(5):1037–1046.
Reliability of motor cortex transcranial magnetic stimulation in four muscle representations
, Clin Neurophysiol.
, vol. 117
(pg. 1037
-1046
) Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31(6):1210–1216.
Treatment-induced cortical reorganization after stroke in humans
, Stroke.
, vol. 31
(pg. 1210
-1216
) Liepert J, Miltner WH, Bauder H, et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett. 1998;250(1):5–8.
Motor cortex plasticity during constraint-induced movement therapy in stroke patients
, Neurosci Lett.
, vol. 250
(pg. 5
-8
) Lewis GN, Byblow WD. Neurophysiological and behavioural adaptations to a bilateral training intervention in individuals following stroke. Clin Rehabil. 2004;18(1):48–59.
Neurophysiological and behavioural adaptations to a bilateral training intervention in individuals following stroke
, Clin Rehabil.
, vol. 18
(pg. 48
-59
) Stinear JW, Byblow WD. Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity poststroke: A pilot study. J Clin Neurophysiol. 2004;21(2):124–131.
Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity poststroke: A pilot study
, J Clin Neurophysiol.
, vol. 21
(pg. 124
-131
) Meesen RLJ, Cuypers K, Rothwell JC, Swinnen SP, Levin O. The effect of long-term TENS on persistent neuroplastic changes in the human cerebral cortex. Hum Brain Mapp. 2011;32(6):872–882.
The effect of long-term TENS on persistent neuroplastic changes in the human cerebral cortex
, Hum Brain Mapp.
, vol. 32
(pg. 872
-882
) Cuypers K, Levin O, Thijs H, Swinnen SP, Meesen RLJ. Long-term TENS treatment improves tactile sensitivity in MS patients. Neurorehabil Neural Repair. 2010;24(5):420–427.
Long-term TENS treatment improves tactile sensitivity in MS patients
, Neurorehabil Neural Repair.
, vol. 24
(pg. 420
-427
)
This content is only available as a PDF.
