Dose-response effects of peripheral nerve stimulation and motor training in stroke: Preliminary data

Stroke is one of the most devastating and prevalent diseases. However, efforts to limit tissue damage in acute stroke have met with only minimal success. Therefore, it is of paramount importance to establish effective therapies for use during long-term stages of recovery. Such therapy can capitalize on neuroplastic change (brain reorganization), which has been associated with recovery of function after brain lesions. Intensive, repetitive motor training is a therapeutic intervention that has been shown to support neuroplastic change and improve motor performance after stroke. Likewise, sensory input in the form of peripheral nerve stimulation (PNS) has been shown to upregulate neuroplasticity and improve motor performance after stroke. However, no studies have evaluated how pairing intensive motor training with various PNS intensities and times may affect motor performance, particularly for subjects with severe upper extremity (UE) hemiparesis after stroke. Here, we describe our ongoing study of whether various intensities and times of delivery of PNS relative to motor training will yield differential effects on UE motor function in subjects with chronic, severe motor deficit after stroke. Our results will facilitate development of a dose-response model for PNS paired with intensive, repetitive motor training, which will help optimize this combinatory intervention for stroke survivors with highest need.