Nerve Stimulation to Improve Hand Weakness in Stroke

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DESCRIPTION (provided by applicant): This proposal intends to develop a novel therapy to increase muscle strength and decrease hand motor disability in chronic stroke patients. There is no universally accepted treatment for long-term motor disability from stroke. Hand motor function significantly impacts independence of stroke patients. Somatosensory input influences activity in the motor cortex and is required for adequate motor performance and motor learning. We have shown that somatosensory stimulation in the form of electrical nerve stimulation, a straightforward and well-tolerated intervention, results in improvement in hand muscle strength when applied to the weak hand of chronic stroke patients, even in the absence of training. Patients with moderate to severe hand disability cannot train well. We will compare the effects of electrical nerve stimulation and motor training to motor training alone, in patients with moderate to severe hand disability, to whom there is no effective alternative treatment available. We expect to generate preliminary data regarding the hypothesis that the stimulation will enhance the effects of training. We will evaluate patient compliance to the research protocol, and will also collect pilot data regarding biological and social/environmental factors that can influence the response to rehabilitative interventions in a Brazilian population. The influence of age, neurophysiological measurements of corticomotor function, family support and social status will be evaluated. It is important to determine which factors underlie response to treatment because, if such knowledge were available, it would be possible to adapt therapies and guide health policies to target these factors. This proposal will provide training in neurophysiological and neurorehabilitation research. We will build research capacity and develop collaboration for future studies regarding: effectiveness of electrical stimulation and training in improving hand strength and decreasing motor disability in chronic stroke patients; prognostic factors for response to rehabilitation therapy. The research will be conducted in a reference university hospital, with full support from the Neurology Department, and will contribute to institutional excellence. This research intends to develop a novel rehabilitative strategy for a condition for which there is no universally accepted treatment, targeting real-life outcomes in a developing country. If successful, these goals may have a major impact in the way chronic stroke patients are treated. The results will be highly valuable to populations in which disability from stroke represents a challenge to health care.