A Single Trial of Transcutaneous Electrical Nerve Stimulation (TENS) Improves Spasticity and Balance in Patients with Chronic Stroke

Abstract

Spasticity management is pivotal for achieving functional recovery of stroke patients. The purpose of this study was to investigate the effects of a single trial of transcutaneous electrical nerve stimulation (TENS) on spasticity and balance in chronic stroke patients. Forty-two chronic stroke patients were randomly allocated into the TENS (n = 22) or the placebo-TENS (n = 20) group. TENS stimulation was applied to the gastrocnemius for 60 min at 100 Hz, 200 µs with 2 to 3 times the sensory threshold (the minimal threshold in detecting electrical stimulation for subjects) after received physical therapy for 30 min. In the placebo-TENS group, electrodes were placed but no electrical stimulation was administered. For measuring spasticity, the resistance encountered during passive muscle stretching of ankle joint was assessed using the Modified Ashworth Scale, and the Hand held dynamometer was used to assess the resistive force caused by spasticity. Balance ability was measured using a force platform that measures postural sway generated by postural imbalance. The TENS group showed a significantly greater reduction in spasticity of the gastrocnemius, compared to the placebo-TENS group (p < 0.05). TENS resulted in greater balance ability improvements, especially during the eyes closed condition (p < 0.05). However, these effects returned to baseline values within one day. This study shows that TENS provides an immediately effective means of reducing spasticity and of improving balance in chronic stroke patients. The present data may be useful to establish the standard parameters for TENS application in the clinical setting of stroke.

Task-Related Training Combined with Transcutaneous Electrical Nerve Stimulation Promotes Upper Limb Functions in Patients with Chronic Stroke

“…This result indicates that TENS may be effective for reduction of muscle spasticity. A growing number of studies have reported on the relationship between electrical stimulation and spasticity (Ozer et al 2006;Miller et al 2007;Bakhtiary and Fatemy 2008;Cho et al 2013). In this study, the reduction in spasticity was comparable to that reported by Bakhtiary and Fatemy.…”

“…They investigated the effect of electrical stimulation on plantarflexor spasticity in patients with stroke, and suggested that electrical stimulation may effectively reduce spasticity and improve motor performance (Bakhtiary and Fatemy 2008). In addition, Cho et al (2013) demonstrated that TENS effectively induced a decrease in spasticity in TENSapplied muscle and increased postural balance in patients with chronic stroke. They observed a positive correlation between spasticity and postural balance, supporting that decreasing spasticity plays an important role in improvement of balance function or motor performance.…”

Relationship between the Application of TENS to the Lower Limbs and Balance of Healthy Subjects

“…Cho et al4 ) reported that TENS improved spasticity and balance of patients with chronic stroke. Guariglia et al5 ) noted that the application of TENS to the neck muscles on the paretic side of patients with hemispatial neglect improved postural control and spatial orientation.…”

Effect of electrical stimulation on blood flow velocity and vessel size

“…IFC uses a current in the mid-frequency range of 1-100 KHz; it is an amplitude-modulated alternative current produced by cross-interference of different currents within the body, thereby transmitting a burst frequency in the biological range into a continual flow of electric potential [11]. In addition, evidence-based approaches of the objective circumstances are required for electrical stimulation conditions and levels [12].…”