Archive for category Spasticity

[Abstract] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

• Sensory function after stroke is a prognostic factor in the achievement of functional performance.

• Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.

• Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function (P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb (P = .0001, Cohen’s d = 1.32), and spasticity (P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0894113020300764?dgcid=rss_sd_all

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[Abstract] Electroacupuncture with rehabilitation training for limb spasticity reduction in post-stroke patients: A systematic review and meta-analysis – Review

ABSTRACT

Objective

To assess the effectiveness of electroacupuncture (EA) with rehabilitation training in reducing limb spasticity in post-stroke patients.

Methods

A systematic review was performed by electronically searching six databases (Medline/Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure, Database for Chinese Technical Periodicals, and Wanfang Data) for randomized controlled trials (RCTs) on EA with rehabilitation training for limb spasticity reduction in post-stroke patients from 1 January 2009 to 1 January 2019. A meta-analysis was performed using SAS 9.3 and RevMan 5.3 software after bibliography screening, data extraction, and risk of bias assessment using the Cochrane handbook. The primary outcome was spasticity.

Results

A total of 31 RCTs (including 2488 participants) were included. Except for Cai et al.’s study, the quality of other RCTs was not high. All studies performed a descriptive analysis, and 29 RCTs conducted a meta-analysis. The odds ratio (OR) for marked efficiency was 2.35 (95% confidence interval [CI] 1.68–3.27, Z = 5.03, P < .00001). The OR for Modified Ashworth Scale (MAS) classification was 2.42 (95% CI 1.89–3.10, Z = 7.03; P < .00001). The weighted mean difference (WMD) for MAS score was −0.68 (95% CI −0.79 – −0.56, Z = 11.24, P < .00001). The WMD for clinical spasticity index score was −1.50 (95% CI −2.28 – −0.72, Z = 3.79, P = .0002).

Conclusion

EA with rehabilitation training could be a good strategy for reducing limb spasticity after stroke and is better than EA alone or rehabilitation training alone. However, its effectiveness remains to be further verified by large-sample and high-quality RCTs

Source: https://www.tandfonline.com/doi/full/10.1080/10749357.2020.1812938?af=R&utm_source=researcher_app&utm_medium=referral&utm_campaign=RESR_MRKT_Researcher_inbound

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[Abstract + References] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

  • Sensory function after stroke is a prognostic factor in the achievement of functional performance.
  • Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.
  • Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function ( P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb ( P = .0001, Cohen’s d = 1.32), and spasticity ( P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.jhandtherapy.org/article/S0894-1130(20)30076-4/fulltext?rss=yes

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[Abstract] Effectiveness of Dry Needling in the Management of Spasticity in Patients Post Stroke

Abstract

Objective: To determine the effectiveness of the dry needling technique (DNT) in the treatment of spasticity for individuals with stroke. 

Design: We reviewed the Embase, Pubmed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We also performed a manual search of the references that are included in the selected articles. Studies included were: i) randomized clinical trials (RCTs); ii) involving patients with a diagnosis of stroke; and iii) using DNT alone or in a multimodal treatment. Muscular spasticity was the primary outcome of the study. The additional outcomes included were: pressure pain sensitivity, range of motion and perception of pain. The analysis of the certainty of the evidence was analyzed using GRADE. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias Tool for Randomized Controlled Trials. 

Results: A total of six RCTs with 221 patients were included in this systematic review, where a significant decrease in spasticity was observed in most of the muscles evaluated, though the certainty of the evidence was low. The effects were only evaluated in the short term in all included studies and the sample size was small. 

Conclusion: These results should be taken with caution because the included studies are few in number and have different comparators. More RCTs are needed to cover aspects of biases found in the literature, in particular the blinding of participants and personnel.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1052305720306546?dgcid=rss_sd_all&utm_campaign=RESR_MRKT_Researcher_inbound&utm_medium=referral&utm_source=researcher_app

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[ARTICLE] Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke – Full Text

Abstract

Background

Spasticity after lesions of central motor pathways may be disabling and there is a need for new, cost-effective treatment methods. One novel approach is offered by the electro-dress Mollii®, primarily designed to enhance reciprocal inhibition of spastic muscles by multifocal, transcutaneous antagonist stimulation.

Methods

The Mollii® suit was set individually for 20 participants living with spasticity and hemiplegia after stroke and used in the home setting for 6 weeks. Usability and perceived effects were monitored by weekly telephone interviews. Outcome was assessed by use of the NeuroFlexor™ method for quantification of the neural component (NC) of resistance to passive stretch (spasticity), and the modified Ashworth scale (MAS) for total resistance, Fugl-Meyer Assessment of motor recovery for sensorimotor function in upper (FM-UE) and lower extremities (FM-LE), activity performance with the Action Research Arm Test (ARAT), Berg balance scale, 10 m and 6 min walk tests, and perceived functioning with the Stroke Impact Scale.

Results

Compliance was high (mean 19.25 of 21 sessions). Perceived positive effects were reported by 60% and most commonly related to decreased muscle tone (n = 9), improved gait pattern function (n = 7) and voluntary movement in the upper extremity (n = 6). On a group level, the NC decreased significantly in the wrist flexors of the affected hand (p = 0.023) and significant improvements according to FM-UE (p = 0.000) and FM-LE (p = 0.003) were seen after the intervention. No significant difference was detected with MAS or assessed activity performance, except for the ARAT (p = 0.000). FM-UE score change correlated significantly and fairly with the perceived effect in the upper extremity (r 0.498 p = 0.025) and in the corresponding analysis for the FM-LE and perceived effect in the lower extremity (r = 0.469 p = 0.037).

Conclusion

This study indicates that the Mollii® method is feasible when used in the home setting to decrease spasticity and improve sensorimotor function. The results may guide a larger controlled study combined with rehabilitation interventions to enhance effects on activity and participation domains.

Background

Spasticity, in terms of “velocity dependent increase of resistance to passive muscle stretch” [1], is a common manifestation of “muscle overactivity” seen in spastic paresis [2] that may follow lesions of central sensorimotor pathways, such as after stroke, traumatic brain injury, in cerebral palsy or spinal cord injury and may be associated with increased impairments, activity limitations and restrict participation [3,4,5]. In addition to the human costs, the estimated direct costs for managing patients with spasticity after stroke are approximately four times higher than for patients without spasticity [4]. Treatment of spastic paresis is based on comprehensive physiotherapy, which may be combined with pharmacological and surgical treatments if needed. After stroke, today’s first line add-on therapy is by use of intramuscular injections of botulinum toxin A (BTX). There is consistent evidence that focal spasticity and associated disabilities after stroke may be reduced by this treatment [6,7,8,9,10,11,12] but also that issues remain. Recently, a systematic review by Andringa et al. [9] concluded that while treatment with BTX in the upper limb improves passive movement of spastic wrist and fingers as well as self-care, there is also a demonstrated lack of effects on arm-hand activity performance. A corresponding review of the literature on treatment of lower limbs by Gupta et al. [12] found that the evidence on effects on mobility was not robust and pointed out the need for new controlled trials. Although treatment with BTX is well established, it is not generally available, not all patients respond well and the maximal dose does not always allow treatment of multifocal spasticity.

Another treatment approach in this area is modulation of sensorimotor input by use of transcutaneous electrical nerve stimulation (TENS) which can be self-administered and is considered cost-effective, with few side effects and thus a promising alternative or complement to current standard therapies [13]. Recent, systematic reviews suggest that treatment with TENS transcutaneous may have beneficial effects on spasticity after stroke [13,14,15]. These findings, lend support to the new treatment method, the electro-dress Mollii®, evaluated in this study, which offers TENS to be applied at multiple stimulation points.

The Mollii® method has been developed by Inerventions AB, which is a Swedish medtech company, and represents an innovative approach for non-invasive electro-stimulation to reduce spasticity and improve motor function. The Mollii® method is provided in a tight fitting, whole body suit with multiple electrodes that can be set individually. The Mollii® method uses low frequencies and low intensities that evokes sensory input but does not elicit muscle contractions. The theoretical background of this method primarily refers to the concept of reciprocal inhibition, i.e. that sensory input from a muscle may inhibit the activation of an antagonistic muscle through activation of disynaptic reciprocal Ia inhibitory pathways [1617]. Thus, the application of Mollii® aims at stimulating an antagonist muscle (e.g. the anterior tibial muscle) to reduce the reflex mediated muscle over-activity in an antagonist muscle (e.g. the gastrocnemius muscle), by inducing reciprocal inhibition. However, as for conventional low intensity TENS, other mechanisms related to altered sensory input, may also play a role [13].

There is now a growing experience from pilot applications of Mollii® in patients with cerebral palsy and stroke indicating that application of this method is feasible and may have beneficial effects on spasticity related disabilities [18]. However, specific effects on spasticity and how these relate to perceived and assessed functioning and disability remain to be demonstrated.

Thus, the aims of this study were to explore the feasibility of using the Mollii® suit in the home setting for 6 weeks and to explore potential effects on functioning in chronic stroke. Specific aims were to explore the clinical relevance in terms of: 1) perceived usability 2) potential self-reported and assessed changes in spasticity and other functioning after the 6 weeks intervention and 3) if these potential changes were associated with level of functioning and 4) perceived changes in functioning. […]

Continue —-> Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke | SpringerLink

figure1
Fig, 1 Donning of the Mollii® suit – trousers [1] and jacket [2] and connection of the control unit to the suit [3]

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[ARTICLE] Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity – Full Text

Abstract

Background

Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial.

Methods

Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods.

Discussion

The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.

Background

People with spasticity following stroke have significantly higher care costs (particularly direct healthcare costs, and aged care costs) and lower quality of life than those survivors without spasticity [1,2,3]. Therefore, identifying effective therapies to reduce upper-limb spasticity and improve function are an important target for research.

International clinical guidelines support the use of botulinum toxin-A in conjunction with active rehabilitation as the preferred treatment [4]. However, the optimum rehabilitation strategy remains undetermined. There are a lack of adequately powered randomised controlled trials evaluating the effect of botulinum toxin-A injections alone, compared to the injection plus active rehabilitation. However, consideration of the costs of providing care for these patients and ultimately consideration of the cost effectiveness of new therapies (namely, whether they are a worthwhile spend of the constrained resources of the healthcare budget as compared to other potential therapies) is another important factor [5].

There have been few studies of the economic impact of upper-limb spasticity following stroke. Lundström et al. [2] evaluated the healthcare costs for the year following stroke in those with and without spasticity in Sweden, and identified that direct health care costs were four times higher in those with spasticity compared to those without, predominantly due to increased costs of hospital care and post hospital community care (i.e. home help services, residential care etc). However, this study only included hospitalised patients and was based on only 25 participants with spasticity. More recently in the UK, Raluy-Callado [3] evaluated costs of care in over 2900 post-stroke spasticity patients and found that those with spasticity following stroke had double the healthcare costs of those without spasticity with increased hospital care contributing to increased costs in this group, but were not able to include information on home and community care in their estimate. In addition, the potential economic impacts of spasticity following stroke are broad ranging, with loss of workforce productivity among patients and their caregivers which persisit after the event [6]. However, the potential cost-effectiveness of therapies is under-researched, with no economic evaluations to date evaluating the impact of evidence-based movement training combined with botulinum toxin-A injections [178]. Rychlik et al. 2016 evaluated the impact for the health care costs and quality of life of botulinum toxin-A treatment vs usual care without botulinum toxin-A. The study showed a significant improvement in the physical and mental health status of participants over the follow up period. Increased healthcare costs were evident for the participants who received the treatment, but despite higher incremental costs (driven by higher pharmaceutical and nursing home care costs) the study authors concluded the intervention was very likely to be considered cost effective due to the large gains in quality of life attributed to the intervention group compared to usual care. However a key limitation of this study was that it was not randomised and the results may have been influenced by confounding factors in the treatment and usual care groups [1]. Conversely, the BoTULS trial evaluated the clinical and cost effectiveness of treating upper-limb spasticity with botulinum toxin-A plus physical therapy vs physical therapy alone over a 4 week intervention period. The study authors concluded that the intervention had a low probability of cost-effectiveness compared to usual care using the UK reference care willingness to pay threshold of £20,000 for an additional QALY gained [9].

In addition, there is an absence of studies from an Australian perspective. Makino et al. 2018 [8] have published the only Australian based study which evaluated the cost-effectiveness of extending botulinum toxin-A therapy beyond the four treatments currently supported by the Pharmaceutical Benefits Scheme. This study was undertaken from the health-care payer perspective, and therefore included direct healthcare costs in the Markov-state transition model that was developed. It was found that extending the number of treatments beyond four was likely to be considered cost effective. However, the study authors didn’t include costs or benefits from rehabilitation or physical therapy in addition to the botulinum toxin-A in their analysis.

The cost of botulinum toxin-A injections is significant, calculated as $1673 Australian Dollars per treatment cycle and patients may receive multiple cycles of treatment [48]. The InTENSE trial [10] aims to determine the clinical and cost effectiveness of including evidence-based movement training with botulinum toxin-A injections. Therefore, interventions to improve the long-term effect of botulinum toxin-A injections in this group could assist in improving quality of life of patients and reducing their healthcare and broader community care costs. Here we describe in detail the protocol for the economic evaluation to occur alongside the evaluation of clinical effect for the InTENSE trial.[…]

Continue —-> Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity | BMC Health Services Research | Full Text

 

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[Abstract] Comprehensive Use of Dynamic Electrical Neurostimulation and Botulinum Toxin Therapy in Patients with Post-Stroke Spasticity

Abstract

Background

Acute cerebrovascular accident poses a threat to the health of the nation. Dynamic electric neurostimulation decreases the excitability of the receptor apparatus, optimize microcirculatory processes, analgesic and antispasmodic effects.

Methods

This article discusses the rehabilitation of 96 men and women with post-stroke spasticity, mean age of 60.51 ± 4.9 years, in the early recovery period after ischemic stroke, randomized into 4 equal groups: Group 1 received botulinum toxin therapy in combination with dynamic electric neurostimulation and basic therapy, including massage and therapeutic exercises; Group 2 -botulinum toxin therapy and basic therapy; Group 3 – dynamic electric neurostimulation and basic therapy; Group 4 – basic therapy only. Study methods included the use of the Modified Asworth Scale to assess spasticity, the Rivemead Motor Assessment test, and goniometry to assess the range of joint movements.

Results

During a three-week observation, it was found that the inclusion of botulinum toxin therapy and dynamic electrical neurostimulation in the standard therapy of post-stroke spasticity in patients after ischemic stroke in the early recovery period contributed to patients’ recovery.

Conclusions

Botulinum toxin therapy and dynamic electrical neurostimulation contributed to a more significant decrease in spasticity in the proximal and distal parts of the paretic upper extremity. It is also increased the amplitude of voluntary movements in the affected shoulder, elbow, and wrist joints, compared to the separate use of botulinum toxin therapy and dynamic electric neurostimulation as part of basic rehabilitation.

via Comprehensive Use of Dynamic Electrical Neurostimulation and Botulinum Toxin Therapy in Patients with Post-Stroke Spasticity – ScienceDirect

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[Abstract] Effects of Acupuncture Treatment on Lower Limb Spasticity in Patients Following Hemorrhagic Stroke: A Pilot Study

Abstract

Background and purpose: Lower limb spasticity is often a significant problem in stoke rehabilitation. The purpose of this study was to investigate the effects of acupuncture treatment on lower limb spasticity in patients following hemorrhagic stroke.

Methods: Fifty-nine patients following hemorrhagic stroke were randomized to receive acupuncture treatment combined with conventional treatment (treatment group [TG]) or conventional treatment only (control group [CG]). Acupuncture treatments were given in 24 sessions over 4 weeks. Blinded evaluation was based on Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio as the primary outcomes. In addition, Fugl-Meyer Assessment (FMA), Barthel Index (BI), motor evoked potential (MEP) and surface integrated electromyogram (IEMG) were employed as the secondary outcomes. All the evaluations were performed at 14 and 28 days after the start of the treatment.

Results: Compared with the CG, the TG showed a significantly greater over-time decrease in MAS for knee (p = 0.022) and ankle (p = 0.017), SICI (p = 0.000) and Hmax/Mmax ratio (p = 0.000). In all patients of TG, we found a greater improvement in lower-limb FMA and MEP but not in BI. IEMG show that TG obtained a greater reduction in spastic agonist muscles and a greater enhancement in spastic antagonist muscles. A significant correlation between a greater decrease in ankle MAS and a greater increase in SICI for spastic muscles was found (r = 0.390, p = 0.002).

Conclusions: Acupuncture could improve the lower limb spasticity and motor function, thus providing a safe and economical approach for treating stroke patients. The potential mechanism underpinning the greater improvement may be attributed to a reshape of corticospinal plasticity induced by acupuncture.

via Effects of Acupuncture Treatment on Lower Limb Spasticity in Patients Following Hemorrhagic Stroke: A Pilot Study – PubMed

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[Abstract + References] The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis

To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors.

A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out.

The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb.

A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was −0.28; with a 95% confidence interval (CI) from −0.54 to −0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was −1.78; 95% CI from −2.02 to −1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term.

The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.

via The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis – Rosa Cabanas-Valdés, Pol Serra-Llobet, Pere Ramón Rodriguez-Rubio, Carlos López-de–Celis, Mercé Llauró-Fores, Jordi Calvo-Sanz, 2020

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[ARTICLE] Balance trainer training with transcutaneous electrical nerve stimulation improves spasticity and balance in persons with chronic stroke – Full Text PDF

Abstract
Objective: The purpose of this study was determine the effect of Balance Trainer training with Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity and balance in persons with chronic stroke.
Design: Randomized controlled trial.
Methods: A total of 30 subjects with hemiparetic stroke were recruited and randomly divided into the Balance Trainer training with TENS group (n=15) and Balance Trainer training with placebo TENS group (n=15). The Balance Trainer training with TENS group practiced additional Balance Trainer training with TENS for 30 minutes a day, 5 days per a week during 4 weeks and the Balance Trainer training with placebo TENS group practiced additional Balance Trainer training with placebo TENS for the same period. Spasticity and balance were assessed by ability (static balance, dynamic balance) and were measured before and after the 4-week programs.
Results: The result of spasticity and dynamic balance were improved significantly in both groups (p<0.05). The Balance Trainer training with TENS group showed significantly greater improvement in spasticity of the gastrocnemius & dynamic balance, compared to the Balance Trainer training with placebo TENS group (p<0.05). The Balance trainer training with TENS group showed a significant improvement in static balance, especially during the eye-closed condition (p<0.05).
Conclusions: The Balance Trainer training with TENS was effective in improving spasticity and balance in subjects with chronic stroke. Based on these results, it is suggested that Balance Trainer training with TENS could clinically be used more actively in conjunction with conventional physical therapy.

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via Balance trainer training with transcutaneous electrical nerve stimulation improves spasticity and balance in persons with chronic stroke

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