Effects of stimulation parameters on modification of spinal spasticity

Vodovnik, L.; Stefanovska, Aneta; Bajd, Tadej

doi:10.1007/bf02443365

Cited by 16 publications

(7 citation statements)

References 12 publications

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“…Short periods of muscle stimulation have been reported to increase the relaxation index (i.e. decrease spasticity: Bowman & Bajd, 1981;Kawamura et al 1987;Vodovnik, Stefanovska & Bajd, 1987;Robinson, Kett & Bolam, 1988 a) or to decrease stretch reflexes and joint compliance (Jaeger & Kralj, 1982). However, to our knowledge short-term effects on resting muscle tone itself have not been investigated under such conditions.…”

Section: Introductionmentioning

confidence: 99%

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia

Douglas

Walsh²,

Wright³

et al. 1991

Experimental Physiology

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SUMMARYResting muscle tone of the leg was measured in terms of thigh muscle stiffness and knee resonant frequency in muscles of spinal cord injured subjects who had been involved in an electrical neuromuscular stimulation training programme of the thigh muscles over at least 2 months. The thigh circumference of these patients was 6-6 % larger than before training commenced (P < 0-001) and showed increased muscle stiffness and resonant frequency compared to a similar group of paralysed subjects who had not used any neuromuscular stimulation. Resonant frequency and stiffness after the long-term training were similar to those of non-injured controls and therefore the stimulation programme seemed to reverse the effects of paralysis on muscle tone. Short periods of rest (30 min) caused increased muscle stiffness in non-injured controls and paralysed muscles trained by neuromuscular stimulation. Additional 15 min periods of neuromuscular stimulation further increased muscle stiffness in the trained muscles but also in the muscles of paralysed subjects who had no long-term neuromuscular training. In contrast, 15 min sessions of passive movement of the knee decreased muscle stiffness in long-term trained paralysed muscles and untrained paralysed muscles. Knee resonant frequency was also significantly decreased in the trained paralysed muscles. Results show that muscle tone varies depending on the amount of previous movement or rest and that although neuromuscular stimulation of paralysed muscles increases muscle stiffness and knee resonant frequency, it is in fact restoring such properties of the muscle to a state approaching that of non-injured controls

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Section: Introductionmentioning

confidence: 99%

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia

Douglas

Walsh²,

Wright³

et al. 1991

Experimental Physiology

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“…Fourteen of the included studies used the Pendulum test to measure changes in spasticity. Of these 14 studies, 8 reported Pendulum test results as the Relaxation Index (R 2n ) [described by Bajd and Vodovnik (57)] (30,44,47,54,42,58) [with one reporting results as the change in R 2n (59)], 4 as the first swing excursion (40, 41, 45, 52), [defined as "the angle at which the movement of the lower leg reverses from flexion to extension after release of the heel" (40)]. One study only reported the statistical analysis of their Pendulum test results (55), and the remaining study did not report their results as they were statistically non-significant (32).…”

Section: Included Studiesmentioning

confidence: 99%

“…The range of ES frequencies used in studies included in this systematic review was 5-1000 Hz. The range of pulse widths used was 0.01-100 ms. One study investigated the effects of TENS delivered with varying frequency/pulse width (ms) pairs, which were as follows: 100/0.1, 100/0.01, 100/1, 1000/ 0.1, 1000/0.01, 10/0.1, 10/0.01, 10/1 (59). The distribution of frequencies and pulse widths used in studies which used a single frequency value, which was stated, is shown in Figure 2.…”

Section: Stimulation Parametersmentioning

confidence: 99%

Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis

Massey

Vanhoestenberghe

Duffell

2022

Front. Rehabilit. Sci.

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This systematic review and meta-analysis aims to determine whether non-invasive electrical stimulation (ES) is effective at reducing spasticity in people living with spinal cord injury (SCI). PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases were searched in April 2022. Primary outcome measures were the Ashworth scale (AS), Modified Ashworth scale (MAS), Pendulum test and the Penn spasm frequency scale (PSFS). Secondary outcomes were the Hoffman (H)- reflex, motor-evoked potentials (MEPs) and posterior-root reflexes (PRRs). A random-effects model, using two correlation coefficients, (Corr=0.1, Corr=0.2) determined the difference between baseline and post-intervention measures for RCTs. A quantitative synthesis amalgamated data from studies with no control group (non-RCTs). Twenty-nine studies were included: five in the meta-analysis and 17 in the amalgamation of non-RCT studies. Twenty studies measured MAS or AS scores, 14 used the Pendulum test and one used the PSFS. Four measured the H-reflex and no studies used MEPs or PRRs. Types of ES used were: transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal cord stimulation (TSCS), functional electrical stimulation (FES) cycling and FES gait. Meta-analyses of 3 studies using the MAS and 2 using the Pendulum test were carried out. For MAS scores, non-invasive ES was effective at reducing spasticity compared to a control group (p = 0.01, Corr=0.1; p = 0.002, Corr=0.2). For Pendulum test outcomes, there was no statistically significant difference between intervention and control groups. Quantitative synthesis of non-RCT studies revealed that 22 of the 29 studies reported improvement in at least one measure of spasticity following non-invasive ES, 13 of which were statistically significant (p < 0.05). Activation of the muscle was not necessary to reduce spasticity. Non-invasive ES can reduce spasticity in people with SCI, according to MAS scores, for both RCT and non-RCT studies, and Pendulum test values in non-RCT studies. This review could not correlate between clinical and neurophysiological outcomes; we recommend the additional use of neurophysiological outcomes for future studies. The use of TSCS and TENS, which did not induce a muscle contraction, indicate that activation of afferent fibres is at least required for non-invasive ES to reduce spasticity.

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“…The duration of effect is known to be proportional to the stimulation time. 48 The stimulation protocol in this study (30 minutes of TENS & FES) was determined according to previous studies 32,34 that incorporated stimulus durations from 20-60 minutes. These studies showed that effects on spasticity may range from short term (minutes) to longer term (hours).…”

Section: Fes and Spasticitymentioning

confidence: 99%

Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial

Sivaramakrishnan

Solomon

Natarajan

2017

The Journal of Spinal Cord Medicine

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Effects of stimulation parameters on modification of spinal spasticity

Cited by 16 publications

References 12 publications

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia

Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis

Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial

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