Sensory Stimulation to Enhance Hand Function Post Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The objective of this pilot project is to assess the impact of the novel sensory stimulation
      technique the investigators have developed in enhancing outcomes of hand therapy as well as
      the central nervous system responsiveness in chronic stroke survivors.
    

Detailed description: 
      Stroke survivors suffer from persistent hand impairment that diminishes their functional
      abilities and independence, despite multiple courses of rehabilitation. Sensory stimulation
      can prime central excitability to increase therapy outcome. The investigators developed a new
      sensory stimulation technique for the hand, using imperceptible vibration applied to the
      wrist skin. Wearable devices with a vibrating function are low cost and can be easily adopted
      for rehabilitation purposes to impact a wide range of patients with sensorimotor impairment.
      Despite the potential for clinical benefits and easy adoption for high impact, knowledge
      about the long-term efficacy of this new sensory stimulation technique and its underlying
      mechanism is limited.

      The objective of this pilot project is to assess the impact of the novel sensory stimulation
      technique the investigators have developed in enhancing outcomes of 2-week hand therapy as
      well as the central nervous system responsiveness in chronic stroke survivors. This impact
      will be assessed in a double-blind stratified randomized controlled trial. The hypothesis is
      that (a) improvement in hand function will be greater for the experimental group receiving
      the wrist subthreshold vibrotactile stimulation during therapy compared with the control
      group who will wear the device with no vibration (placebo). (b) Improvement in hand function
      is associated with neurophysiologic measures of central nervous system responsiveness.
      Clinical and neurophysiologic evaluations will be performed before, immediately after, and 2
      weeks after a 2 week standardized hand therapy program with the subthreshold vibrotactile
      stimulation to the wrist vs. sham. The investigators preliminary studies demonstrated an
      acute effect of the remote subthreshold vibrotactile stimulation on immediately improved
      clinical sensory and motor function of the hand as well as cortical excitability in healthy
      young adults and chronic stroke survivors in single-session studies.

      The expected outcome is the demonstration that the subthreshold vibrotactile stimulation at
      the wrist enhances hand function, not only immediately (preliminary studies) but also as a
      complement to therapy in chronic stroke survivors. This project will also provide preliminary
      insights regarding plasticity occurring with hand therapy augmented by the subthreshold
      vibrotactile stimulation. This research will have a positive impact by leading to a portable
      sensorimotor orthosis worn at the wrist to improve hand function for patients with
      sensorimotor deficits.
    

Intervention name(s): Vibration; Placebo (for vibration); therapy
Intervention type(s): Other; Other; Behavioral
Intervention description(s): peripheral vibration at the wrist skin at an imperceptible level; No peripheral vibration at the wrist skin; standardized hand therapy program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: hand function