Posts Tagged physical therapy

[Abstract] Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review

Background and purpose: Transcranial direct current stimulation (tDCS) has been extensively studied over the past 20 years to promote functional motor recovery after stroke. However, tDCS clinical relevance still needs to be determined. The present systematic review aims to determine whether tDCS applied to the primary motor cortex (M1) in stroke patients can have a positive effect on functional motor outcomes.

Materials and methods: Two databases (Medline & Scopus) were searched for randomized, double-blinded, sham-controlled trials pertaining to the use of M1 tDCS on cerebral stroke patients, and its effects on validated functional motor outcomes. When data were provided, effect sizes were calculated. PROSPERO registration number: CRD42018108157

Results: 46 studies (n = 1291 patients) met inclusion criteria. Overall study quality was good (7.69/10 on the PEDro scale). Over half (56.5%) the studies were on chronic stroke patients. There seemed to be a certain pattern of recurring parameters, but tDCS protocols still remain heterogeneous. Overall results were positive (71.7% of studies found that tDCS has positive results on functional motor outcomes). Effect-sizes ranged from 0 to 1.33. No severe adverse events were reported.

Conclusion: Despite heterogeneous stimulation parameters, outcomes and patient demographics, tDCS seems to be complementary to classical and novel rehabilitation approaches. With minimal adverse effects (if screening parameters are respected), none of which were serious, and a high potential to improve recovery when using optimal parameters (i.e.: 20 min of stimulation, at 2 mA with 25 or 35cm2 electrodes that are regularly humidified), tDCS could potentially be ready for clinical applications.

  • Implications for Rehabilitation
  • tDCS could potentially be ready for clinical application.

  • Evidence of very low to very high quality is available on the effectiveness of tDCS to improve motor control following stroke.

  • This should with caution be focused on the primary motor cortex.

via Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review: Disability and Rehabilitation: Vol 0, No 0

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[WEB PAGE] Physical Therapy at Home – Gorbel Rehab – Videos

Physical Therapy at Home

As rehab professionals around the world work to address patient needs during the COVID-19 pandemic, Gorbel is actively taking steps to improve efforts in delivering therapy during these difficult times. The Gorbel team of physical therapists have created a library of home exercise program videos for those patients who are now unable to receive therapy with the frequency or duration in which they normally would have. The current video categories are Strength, Range of Motion, Balance, and Caregiver Training. Each category has a ‘Playlist’ that includes multiple videos. We will continue to add categories and new videos in our commitment to assist your efforts to advance your patient’s recovery.

Stay safe, healthy and thank you for all you do.
Brian Reh, CEO Gorbel®


Physical Therapy Videos

Balance Videos Playlist  /  Caregiver Videos Playlist  /  Range of Motion Videos Playlist  /  Strength Videos Playlist

Balance Videos Playlist

Caregiver Videos Playlist

Range of Motion Videos Playlist

Strength Videos Playlist


Physical Therapist Bio

Matthew KlockMatthew Klock PT,DPT I am a licensed physical therapist in New York State and the Northeast Account Manager for Gorbel® Rehabilitation. Before joining Gorbel® I worked for Ochsner Health System in New Orleans, LA as the Supervisor of the Ochsner Sports Medicine Clinic. My passions include sports and orthopedics as well as new and emerging technologies. I believe that physical therapists should serve their patients by applying their wealth of knowledge in rehabilitation and pair it with the most cutting edge technologies to get the most out of every treatment.


Ramiro MaldonadoRamiro Maldonado PT, DPT I am a licensed Physical Therapist in New York State as well as the Clinical Business Development Specialist for Gorbel Rehabilitation. During my ten years as a clinician, my clinical interests lead me to specialize in vestibular and neuromuscular impairment, and I have completed the vestibular competency at Emory University. My passion now lies in helping patients and therapists by increasing awareness of rehabilitation technology and how it can improve patient outcomes. You can find out more about the products I represent, innovations in physical therapy, and me at or follow me on Twitter or Instagram @RamiroDPT. Thank you!! 

Heidi ShenkHeidi Shenk, PT I am a licensed Physical Therapist in the states of Ohio and Indiana as well as the Account Manager for the Great Lakes Region of Gorbel Rehabilitation. I am a graduate of the Doisy College of Health Sciences at St Louis University. During my twenty-seven years as a clinician, my clinical interests led me to specialize in occupational medicine, outpatient orthopedics and in women’s health. My lifelong interest in technology and in improving therapist safety and patient outcomes has led to a passion in increasing awareness of rehabilitation technology and how it can improve patient care.

via Physical Therapy at Home | Gorbel Rehab

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[WEB PAGE] How to Treat Neurological Conditions with Physical Therapy

PHYSICAL THERAPY HELPS people improve their movement. You may think of physical therapy as something you use after a sports injury or after certain types of surgery. However, physical therapy helps with a variety of health issues. For example, breast cancer patients who have had their lymph nodes removed often get physical therapy to help with lymphedema. Physical therapy can also help with neurological disorders.


Neurological disorders (also called neurological diseases or conditions) affect the brain, spinal cord or nervous system. There are more than 1,000 neurological diseases. Some examples include:

Nearly 100 million Americans were affected by neurological disorders in 2011, according to a report in the Annals of Neurology. This number will likely increase as the population ages. Stroke and Alzheimer’s disease were the fourth- and fifth-highest killers in the U.S. in 2017, according to the Centers for Disease Control and Prevention.


Physical therapists are trained, licensed professionals who focus on evaluating and treating problems that affect any type of movement, says Anne Aldrich, a board-certified clinical specialist in pediatric physical therapy at CHOC Children’s, a pediatric health care system in Orange, California.


Physical therapists help to improve movement, so people can more easily do the things they want to do, says physical therapist Julie A. Blank, owner of On the Go Therapy Services in Sarasota, Florida.


Physical therapy is a good fit for many people with neurological disorders because they may have problems with their movement. These problems are often caused by the disorder. Depending on the type of neurological condition someone has, movement problems can get worse as the disease progresses. This is the case with conditions like Alzheimer’s disease, Parkinson’s disease and ALS.

How Physical Therapy Can Help

“These impairments can be small or large and can have a varying impact on an individual’s ability to move,” Aldrich says. Here are a few examples of how movement problems affect people with neurological disorders – and how physical therapy can help:

  • A man had a stroke eight years earlier. The stroke caused him to walk abnormally. Now his knee hurts due to the way he walks. He wants his knee pain to get better.
  • A child with a neurological disorder may need to learn to walk with a cane. Before doing this, she needs to practice sitting and standing. Then eventually, she can learn to walk with the cane.
  • A woman has a traumatic brain injury. Now her feet and hands aren’t moving together when she walks.
  • A man with ALS wants to learn some simple exercises to help avoid joint pain and stiffness.
  • Caregivers for a woman with Alzheimer’s disease want to help prevent her from falling. A physical therapist practices balance exercises with her to reduce her fall risk.
  • A physical therapist helps a woman with migraines by performing manual therapy, which is a manipulation of the muscles used by physical therapists and other health professionals. These movements help to decrease pain and expand mobility in the head and neck.
  • An older man with Parkinson’s disease has physical therapy to help with repetitive twisting of the foot, which can happen with Parkinson’s. The exercises done in physical therapy help to strengthen his foot.

Physical therapists tailor their care to each patient. They work with patients to create realistic goals. This means the therapy that one person receives will be very different from the therapy someone else gets. For instance, a person who needs a little training with the mobility equipment he or she uses will have very different needs than someone who has just had a stroke and needs to get back to work in a couple of months, says American Physical Therapy Association spokeswoman Alison M. Lichy. She is also the owner of Neurological Physical Therapy in Falls Church, Virginia.

What to Expect

Goals for physical therapy also are tailored for each person, and so are the frequency of physical therapy sessions. A person in the hospital due to a recent stroke or other major neurological injury may receive physical therapy and other types of therapy at the hospital a couple of times a day to help speed up progress.

Other patients may see a physical therapist a couple of times a week at a physical therapist’s office, although some therapists will come to a person’s home.


Sessions also can be done:

  • In a gym.
  • At hospice.
  • In a classroom or on a playground, which would be options for children.

It’s important to start physical therapy for neurological conditions as early as possible. Physical therapy can’t stop these conditions or their effects on movement entirely, but it can help slow down their progression, Blank says. “We can help to maintain things like good posture, balance and strength,” Blank notes. It’s harder to get good results if physical therapy starts later on.

Physical therapists help their patients get better with regular, repetitive exercises. Depending on a person’s goals, this can include practice with:

  • Balance.
  • Strengthening.
  • Stretching.

Even if the movements done during those exercises aren’t perfect, they help retrain the muscles and the brain to work together – something they may not have done for a long time.


Physical therapy for children with neurological disorders is a little different because sessions can be set up as playtime. For example, a therapist may have a child reach for a toy to help get them to practice rolling over or balance on one foot while playing ring toss in a pool. “This can make pediatric physical therapy both fun and satisfying for children and their parents,” Aldrich says.


An important part of physical therapy is the practice done outside of therapy sessions. Lichy says, “(Patients) need to know how to do activities at home and do them safely to maximize what they do outside of physical therapy.”


Patients who are motivated to progress tend to do better than those who want to be left alone. Blank says, “Our main job isn’t to provide therapy. It’s to teach and equip you to help you succeed moving forward. We give you the tools to help you get better or maintain what you have.”

Getting the Most Out of Physical Therapy for Neurological Disorders

If you or someone you care for needs physical therapy to help with a neurological condition, there are a few tips to keep in mind to get the best care possible:


1. Find out about the therapist’s experience with neurological disorders. There are physical therapists who have a designation called neurologic clinical specialist, or NCS. Although physical therapists all have some knowledge of neurological disorders, those with the NCS designation have passed a special test to expand their expertise in this area. The American Physical Therapy Association can help people find a physical therapist and allows users to specialize if they want someone with neurological expertise.


2. Clearly communicate about your problem. If your movement problem isn’t something that can’t be recreated when you first see a physical therapist, then try to take pictures or videos at home, and bring them with you, Aldrich advises.


3. Speak up if you need more care. Many patients in today’s health care system feel their care is limited by what their insurance is willing to pay, Blank says. This can leave them feeling frustrated, especially if they still feel they need more care. Let your physical therapist know if that’s your situation. Some will work with you to file additional paperwork for more sessions or to offer additional care, Blank says.


4. Practice your assigned exercises at home. This can’t be stressed enough. Doing designated exercises outside of physical therapy sessions can make a big difference in rebuilding your strength or preventing a further loss of movement if you have a worsening condition.

Vanessa Caceres, Contributor

Sources: Anne Aldrich, PT, DPT, PCSJulie A. Blank, PTAlison Lichy, PT, DPT, NCS

via How to Treat Neurological Conditions with Physical Therapy | U.S. News

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[Abstract] Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis

Stroke is the main cause of disability in adulthood. Recent advances in virtual reality (VR) technologies have led to its increased use in the rehabilitation of stroke patients. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effectiveness of game-based reality on upper limb (UL) motor function and quality of life after stroke. In March 2018, a search of the following databases was performed: PubMed, PEDro, Web of Science, Scopus, The Cochrane Library, and Medline at EBSCO. The selection criteria were all RCTs published in English or Spanish during the past 10 years. The PEDro scale was used to evaluate the methodological quality of the studies. A total of 20 clinical trials were included in the systemic review, of which 15 contributed information to the meta-analysis. Favorable results were found for VR interventions on UL motor function (Fugl-Meyer Assessment for upper extremity, standardized mean difference [SMD] = 1.53, 95% CI [0.51–2.54]) and quality of life (functional independence measure, SMD = 0.77, 95% CI [0.05–1.49]). The results demonstrate the potential benefits of VR interventions on the recovery of UL motor function and on quality of life after stroke.


via Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis | Games for Health Journal

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[Abstract] Psychiatric disorders following traumatic brain injury: a nationwide population-based cohort study and the effects of rehabilitation therapies



To investigate the risk of psychiatric disorders following TBI, and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders.


A register-based, retrospective cohort design


Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015.


This study included 231,894 patients with TBI and 695,682 controls.


Rehabilitation therapies in TBI patients.

Main Outcome Measures

A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders.


The incidence rate of psychiatric disorders was higher in the TBI group when compared with the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (HR=2.056, 95% CI:1.940- 2.172, p < 0.001). Among the TBI subjects, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691, 95% CI: 0.679-0.703, p < 0.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group.


We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.

via Psychiatric disorders following traumatic brain injury: a nationwide population-based cohort study and the effects of rehabilitation therapies – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] TBI MOOC Starts Today! – Physiospot – Physiotherapy and Physical Therapy in the Spotlight

The latest Physiopedia MOOC is up and running today!

If you’re new to the term MOOC it is an acronym for Massive Online Open Course and each year Physiopedia has one for you to take part in for free. The courses Physiopedia have hosted have been hugely successful and have covered a diverse range of topics. This year the topic is Traumatic Brain Injury and it starts today!

The 2019 MOOC aims to provide a basic theoretical understanding of the management of traumatic brain injury in order to equip physiotherapists with sufficient knowledge to manage a person following a traumatic brain injury. This includes assessing impairments, activity limitations and participation restrictions, setting appropriate goals of treatment, formulating an evidence-based treatment plan, implementing treatment and evaluating its success.

Check out the video below to find out more!

How Do I Sign Up?

This is a completely online course which will take place in Physiopedia’s complimentary e-learning platform Physioplus. You will need need to set up a FREE trial account to access the course, you can do that here. The course will become available on the Physioplus site on 21 October 2019, we place the link at the top of this page and also email it to you. If you’d like to know more about the course check out some more details on the PP page dedicated to the MOOC.

Take Part in the MOOC for Free!


The course will be accredited in 32 States in the USA, Australia and South Africa. That’s right this course comes with free CEUs and CPD Credits if you take part and complete the course.

Don’t forget to choose your favourite T-Shirt for our design competition!

via TBI MOOC Starts Today! – Physiospot – Physiotherapy and Physical Therapy in the Spotlight

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[BLOG POST] 5 Smartphone Games That Encourage Wrist Rehabilitation

Tired of using dumbbells for rehabilitation following distal radius fractures? Looking for new interventions to increase client engagement? Look no further than your patient’s smartphone! Incorporate it into exercise routines to help your patients regain wrist balance and to provide proprioceptive input.

Evidence Supports Proprioceptive Activities

Emerging evidence supports the use of proprioceptive activities for distal radius fracture rehabilitation.1 A cross-sectional study involving females treated operatively and non-operatively for a distal radius fracture found that participants had significantly less joint position sense in comparison to study controls.2 The proprioceptive limitations correlated highly with functional impairment on the Patient Rated Wrist Evaluation.3

By addressing proprioceptive deficits while encouraging functional wrist range of motion, smartphone applications complement a traditional hand therapy program for individuals requiring skilled therapy following a distal radius fracture.

Some games to consider:

  • Chopper Lite – Action packed side-scrolling helicopter game where a tilt of the screen flies the chopper.
  • Labyrinth – Classic labyrinth game in which you must guide a ball through a labyrinth by moving your device.
  • Tilt Maze Lite – Maze game where a tilt of your device helps a marble through a maze toward the exit. Use different mazes to test wrist balance and timing. The game stores the player’s best time for each maze so patients can track their performance as their wrist heals.
  • Water Slide Extreme – Unique water slide game featuring tight corners and huge loops that you must navigate by twisting or leaning your device.
  • Snail Mail – Kart-style racing game in which the player controls a racing snail on a mission to collect packages and deliver them to the farthest reaches of the universe while dodging obstacles such as laser towers, slugs, asteroids, and salt.

The clinician should consider using smartphones as an intervention following distal radius fractures. Skilled hand therapists can assist with appropriate postural mechanics and provide guidelines for the amount of time a patient should devote to gaming.

Rehabilitation at Your Fingertips

Certain smartphone applications can be used to address client-specific deficits, decrease functional concerns, and achieve client-centered goals. Incorporating smartphone gaming in hand therapy may provide motivation and convenience to your clients.



  1. Algar, L., & Valdes, K. (2014). Using smartphone applications as hand therapy interventions. Journal of Hand Therapy27(3), 254–257. doi:10.1016/j.jht.2013.12.009
  2. Karagiannopoulos, C., Sitler, M., Michlovitz, S., & Tierney, R. (2014a). A Descriptive Study on Wrist and Hand Sensori-Motor Impairment and Function Following Distal Radius Fracture Intervention. Journal of Hand Therapy27(3), e2–e3. doi:10.1016/j.jht.2013.08.006
  3. Karangiannopoulos, et al. (2014)

via 5 Smartphone Games That Encourage Wrist Rehabilitation | MedBridge Blog

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[WEB SITE] Virtual Reality is Finding a Home in Physical Therapy

Credit to: Neuro Rehab VR

Virtual reality has plenty of applications for fitness — you’re here, so you already know that. However, it is increasingly becoming a tool for rehabilitation, as well. Neuro Rehab VR aims to make physical therapy more enjoyable, and it promises to help patients more than traditional physical therapy.

Making physical therapy fun

With only about one-third of patients fully adhering to their rehabilitation plans, Neuro Rehab VR’s goal was to create a platform that was more engaging without making things more cumbersome. During the early days of the Oculus Rift, with its many sensors, that was not possible.

This was made possible with the Oculus Quest, which eliminated the need for extra equipment or wires. Neuro Rehab VR provides several different exercise applications that run patients through less-abstract goals, such as going grocery shopping. The applications are available for the entire body, and also include sports and combat.

In addition to being more interesting, VR physical therapy can have more effective results. Because of  the brain’s neuroplasticity, Neuro Rehab VR says playing games can establish better connections in the brain as you work toward concrete goals. This can, in turn, lead to more complete recovery. Neuro Rehab VR is partnered with Fort Worth’s Neurological Recovery Center. It has dealt with patients of spinal injuries, brain injuries, strokes, and multiple sclerosis. The team decided to expand and make its systems available elsewhere after seeing its success.

Neuro Rehab VR believes its systems can work not only in hospitals, but also for in-home recovery. The low cost of the Quest itself makes it affordable for rental or purchase by the patient. Therapists can see every movement patients make to determine if they are doing exercises correctly. Once the patient is feeling better, they’ll still have a device capable of helping them stay fit from within their home.

via Virtual Reality is Finding a Home in Physical Therapy

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[Abstract] Soymilk ingestion immediately after therapeutic exercise enhances rehabilitation outcomes in chronic stroke patients: A randomized controlled trial. – NeuroRehabilitation


Study investigated the effects of an 8-week rehabilitation exercise program combined with soymilk ingestion immediately after exercise on functional outcomes in chronic stroke patients.

Twenty-two stroke patients were randomly allocated to either the soymilk or the placebo (PLA) group and received identical 8-weeks rehabilitation intervention (3 sessions per week for 120 minutes each session) with corresponding treatment beverages. The physical and functional outcomes were evaluated before, during, and after the intervention. The 8-week rehabilitation program enhanced functional outcomes of participants.

The immediate soymilk ingestion after exercise additionally improved hand grip strength, walking speed over 8 feet, walking performance per unit lean mass, and 6-Minute Walk Test performance compared with PLA after the intervention. However, the improvements in the total score for Short Physical Performance Battery and lean mass did not differ between groups.

This study demonstrated that, compared with rehabilitation alone, the 8-week rehabilitation program combined with immediate soymilk ingestion further improved walking speed, exercise endurance, grip strength, and muscle functionality in chronic stroke patients.

via Articles, Books, Reports, & Multimedia: Search REHABDATA | National Rehabilitation Information Center

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[WEB SITE] Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke

Adult using TENS machine for lower limb pain

Published on 26 February 2019

doi: 10.3310/signal-000738

Transcutaneous electrical stimulation (TENS) delivered alongside standard physical therapies could reduce spasticity in the lower limbs following a stroke.

Spasticity is a muscle control disorder characterised by tight muscles. It is common after stroke and accounts for significant disability. TENS is often used to treat pain and can affect nervous stimulation of the muscles.

The main evidence in this systematic review came from five trials which suggested that TENS combined with other physical therapies has moderate effect on lower limb spasticity compared with placebo.

The review has limitations, with small studies and little evidence on use for upper limbs or comparing with other therapies. However, TENS machines are portable, inexpensive and widely accessible making them an appealing addition to other care.

NICE does not currently recommend the use of TENS in stroke rehabilitation, though guidance covers use of other types of electrical stimulation in certain other contexts.

Why was this study needed?

More than 1.2 million people in the UK are living with the effects of stroke. About two-thirds of stroke survivors leave hospital with residual disability and one quarter experience spasticity.

Electrical stimulation is sometimes used as treatment after a stroke. It includes functional electrical stimulation and neuromuscular electrical stimulation, which both focus on muscle contraction. Transcutaneous electrical stimulation (TENS) targets the sensory nerves in a different way.

Transcutaneous electrical stimulation has been suggested as an adjunct to other rehabilitation therapy to try and reduce spasticity. The device is portable and can be self-administered at home, so its potential for managing spasticity is appealing.

There have been a number of small studies of TENS with conflicting results. This review aimed to combine the results to see if there was evidence for its use to treat spasticity after stroke.

What did this study do?

This systematic review identified 15 studies (10 randomised controlled trials) reporting the effectiveness of TENS on spasticity after stroke.

Studies compared TENS, used alone or alongside other therapies such as functional exercises, with placebo, no treatment or other treatments. Thirteen studies assessed lower limb spasticity, with 11 targeting the ability to flex the foot. Most assessed use in the chronic rather than acute phase of stroke.

Transcutaneous electrical stimulation regimen varied widely. Intervention periods ranged from one day to 12 weeks, the number of TENS sessions from one to seven per week, and the duration of sessions ranged from less than 20 minutes up to 60 minutes.

Trials were small with maximum participant size 80. The quality of randomised controlled trials was good overall, with lack of participant blinding being the most likely source of bias. Seven trials were pooled in meta-analysis.

What did it find?

  • Transcutaneous electrical stimulation used alongside other physical therapies was moderately effective in reducing spasticity in the lower limbs compared with placebo (standard mean difference [SMD] -0.64, 95% confidence interval [CI] -0.98 to -0.31). This was from meta-analysis of five trials (221 adults) with broadly similar results.
  • Pooled results of two trials (60 adults) also found that TENS alongside other physical therapies was more effective at reducing spasticity than no TENS (SMD -0.83, 95% CI -1.51 to -0.15).
  • Five studies assessed longer-term effects on spasticity. Three studies found the effects were maintained for a period of two to five weeks whilst two studies found the effects lasted for less than a day and that spasticity returned to baseline levels immediately following the intervention.
  • None of the studies reported any adverse effects of TENS.

What does current guidance say on this issue?

The NICE guideline on stroke rehabilitation (2013) does not currently include recommendations for use of TENS. NICE advises against the routine use of electrical stimulation for the hand and arm but suggests a trial of treatment may be considered if there is sign of muscle contraction, and the person cannot move their arm against resistance.

NICE guidance from 2009 advises that there is sufficient evidence that functional electrical stimulation can improve walking in people with drop foot following a stroke, provided the normal arrangements are in place for clinical governance, consent and audit.

What are the implications?

This review suggests that TENS, when delivered alongside other physical therapies, could be considered for lower limb spasticity as part of a stroke rehabilitation programme.

The findings are similar to a 2015 systematic review which found that electrical stimulation gave small but significant improvements in spasticity following stroke. Again this earlier review was limited by small sample sizes, varied treatment regimens and few studies that could be pooled in meta-analysis.

There was insufficient evidence to support use for upper limbs.

Cost was not assessed, but TENS is a non-invasive therapy and devices are widely available and could easily be used at home.

Citation and Funding

Mahmood A, Veluswamy SK, Hombali A, et al. Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018; 16 November. doi: 10.1016/j.apmr.2018.10.016. [Epub ahead of print].

No funding information was provided for this study.


NICE. Functional electrical stimulation for drop foot of central neurological origin. IPG278. London: National Institute for Health and Care Excellence; 2009.

NICE. Stroke rehabilitation in adults. CG162. London: National Institute for Health and Care Excellence; 2013.

NICE. Spasticity (after stroke) – botulinum toxin type A. ID768. London: National Institute for Health and Care Excellence; in development.

Stein C, Fritsch CG, Robinson C et al. Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke. 2015;46(8):2197-205.

Stroke Association. State of the nation: stroke statistics. London: Stroke Association; 2018.


  1. Analysis of the Faster Knee-Jerk In the Hemiplegic Limb
    TAKAO NAKANISHI et al., JAMA Neurology, 1965
  2. Transcutaneous Electrical Stimulation
    WILLIAM BAUER et al., JAMA Otolaryngology Head Neck Surgery, 1986

via Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke

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