Posts Tagged Transcutaneous electrical nerve stimulation

[Abstract + References] Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis

Abstract

Objectives

(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Data Sources

PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.

Study Selection

Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.

Data Extraction

Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.

Data Synthesis

Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.

Conclusion

There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151)

References

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source:
https://www.archives-pmr.org/article/S0003-9993(18)31455-2/abstract

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[Abstract] Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis

Abstract

Background

Clinical studies have shown that sensory input improves motor function when added to active training after neurological injuries in the spinal cord.

Objective

We aimed to determine the effect on motor function of extremities of adding an electrical sensory modality without motor recruitment before or with routine rehabilitation for hemiparesis after stroke by a comprehensive systematic review and meta-analysis.

Methods

We searched databases including MEDLINE via PubMed and the Cochrane Central Register of Controlled Trials from 1978 to the end of November 2017 for reports of randomized controlled trials or controlled studies of patients with a clinical diagnosis of stroke who underwent 1) transcutaneous electrical nerve stimulation (TENS) or peripheral electromyography-triggered sensory stimulation over a peripheral nerve and associated muscles or 2) acupuncture to areas that produced sensory effects, without motor recruitment, along with routine rehabilitation. Outcome measures were motor impairment, activity, and participation outcomes defined by the International Classification of Functioning, Disability and Health.

Results

The search yielded 11 studies with data that could be included in a meta-analysis. Electrical sensory inputs, when paired with routine therapy, improved peak torque dorsiflexion (mean difference [MD] 2.44 Nm, 95% confidence interval [CI] 0.26–4.63). On subgroup analysis, the combined therapy yielded a significant difference in terms of sensory stimulation without motor recruitment only on the Timed Up and Go test in the chronic phase of stroke (MD 3.51 sec, 95% CI 3.05–3.98). The spasticity score was reduced but not significantly (MD − 0.83 points, 95% CI -1.77 − 0.10).

Conclusion

Electrical sensory input can contribute to routine rehabilitation to improve early post-stroke lower-extremity impairment and late motor function, with no change in spasticity. Prolonged periods of sensory stimulation such as TENS combined with activity can have beneficial effects on impairment and function after stroke.

via Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis – ScienceDirect

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[ARTICLE] The immediate effect of FES and TENS on gait parameters in patients after stroke – Full Text PDF

Abstract.

[Purpose] This study was conducted to compare the immediate effects of different electrotherapies on the gait parameters for stroke patients.

[Subjects and Methods] Thirty patients with stroke were randomly assigned either to the functional electrical stimulation group or the transcutaneous electrical nerve stimulation group, with 15 patients in each group. Each electrotherapy was performed for 30 minutes simultaneously with the therapeutic exercise, and the changes in the spatial and temporal parameters of gait were measured.

[Results] After the intervention, a significant, immediate improvement in cadence and speed was observed only in the functional electrical stimulation group.

[Conclusion] Based on this study, functional electrical stimulation that stimulates motor nerves of the dorsiflexor muscles on the paretic side is recommended to achieve immediate improvement in the gait ability of stroke patients.[…]

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[REVIEW] INFLUENCE OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ON SPASTICITY, BALANCE, AND WALKING SPEED IN STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS – Full Text PDF

Objective: To evaluate the influence of transcutaneous electrical nerve stimulation in patients with stroke through a systematic review and meta-analysis.

Methods: PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials assessing the effect of transcutaneous electrical nerve stimulation vs placebo transcutaneous electrical nerve stimulation on stroke were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was modified Ashworth scale (MAS). Meta-analysis was performed using the random-effect model.

Results: Seven randomized controlled trials were included in the meta-analysis. Compared with placebo transcutaneous electrical nerve stimulation, transcutaneous electrical nerve stimulation supplementation significantly reduced MAS (standard mean difference (SMD) = –0.71; 95% confidence interval (95% CI) = –1.11 to –0.30; p =0.0006), improved static balance with open eyes (SMD = –1.26; 95% CI = –1.83
to –0.69; p<0.0001) and closed eyes (SMD = –1.74; 95% CI = –2.36 to –1.12; p < 0.00001), and increased walking speed (SMD = 0.44; 95% CI = 0.05 to 0.84; p = 0.03), but did not improve results on the Timed Up and Go Test (SMD = –0.60; 95% CI=–1.22 to 0.03; p = 0.06).

Conclusion: Transcutaneous electrical nerve stimulation is associated with significantly reduced spasticity, increased static balance and walking speed, but has no influence on dynamic balance.

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[ARTICLE] The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) Applied to the Foot and Ankle on Strength, Proprioception and Balance: A Preliminary Study – Full Text PDF

Abstract

Background: Transcutaneous electrical nerve stimulation (TENS) promotes upper motor neuron excitability which has the potential to improve function. As a precursor to clinical trials, we investigated the potential efficacy of TENS on strength, proprioception and balance in healthy older adults.

Method:

  • Design: A paired-sample randomized crossover trial. No stimulation was the control.
  • Intervention: A one-off session of TENS (Modulated frequency: 70-130Hz, 5 second cycle) via a conductive sock.
  • Participants: 25 healthy older volunteers with no pre-existing balance or mobility limitations or contra-indications to TENS.
  • Outcomes: Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dynamometer and balance (postural sway and forward reach test).
  • Analysis: Paired t-tests

Results: None of the parameters showed any significant changes with TENS (p>0.05).

Conclusions: The stimulation of cutaneous sensory nerve endings of the foot with the application of TENS showed no immediate effect on the ankle proprioception, lower leg muscle strength, and postural stability. The concern that TENS would have a distracting impact on sensation and balance was not supported according to these results.

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