Use of Electrical Stimulation for People With Spinal Cord Injury: A Survey of Occupational Therapy Practitioners

Expert Recommendations for a Clinical Guide Supporting the Use of Electrical Stimulation in Occupational Therapy Treatment of Spinal Cord Injury

IMPORTANCE

Clinical application of electrical stimulation (ES) to address functional deficits for those with spinal cord injury (SCI) is not consistent among occupational therapy practitioners, likely because of limited occupational therapy-specific clinical guidelines (OT-CG). Clinicians report the need for evidence-based guidance that supports their practice.

OBJECTIVE

To identify occupational therapy practitioners' needs to support ES application in treatment sessions, utility of existing clinical practice guidelines for occupational therapy practitioners, challenges and opportunities to translate research findings into clinical practice, and desirable characteristics for an occupational therapy-specific ES clinical guide.

DESIGN

A panel of 7 senior occupational therapy clinicians with ES expertise was convened for two stages. In Stage 1, two focus group discussions were recorded, transcribed, analyzed, and thematically summarized. In Stage 2, panel members completed a member-check survey, and panelists reviewed a proposed outline for an OT-CG ES guide, rating the desirability of each section.

SETTING

Online expert panel.

PARTICIPANTS

A purposive sample of occupational therapy clinicians eligible to administer ES, actively using ES with SCI, and employed at preeminent SCI centers.

RESULTS

An outline for an OT-CG to support consistent clinical use of ES among occupational therapy practitioners was developed. Three themes emerged: difficulty using clinical practice guidelines for electrical stimulation, lack of clinical examples to guide specific electrical stimulation treatment activities, and modifications to existing guidelines.

CONCLUSIONS AND RELEVANCE

An outline for a proposed guideline was created; ideally, such a manual would improve treatment fidelity and predictable patient outcomes for those with SCI. What This Article Adds: A novel outline for an OT-CG was developed to provide treatment fidelity, structure to treatment approaches, and a basis for future scholarly study.

Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review

Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.