Effects of Combined Peripheral Nerve Stimulation and Brain Polarization on Performance of a Motor Sequence Task After Chronic Stroke

Abstract

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 (tDCS _Sham and PNS _Sham ). 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+tDCS _Sham , tDCS+PNS _Sham , and PNS _Sham +tDCS _Sham 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 PNS _Sham +tDCS _Sham , 15.4% relative to PNS+tDCS _Sham , and 22.7% relative to tDCS+PNS _Sham . 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.