Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients

Abstract

To investigate whether transcutaneous electrical nerve stimulation (TENS) mitigates the spasticity of hemiplegic stroke patients, as assessed by electrophysiological variables, and the effects, if any, on the clinical appearance of spasticity. [Subjects and Methods] Twenty-seven subjects who had acute hemiplegia and 24 healthy people as the control group, were enrolled in this study. Some of the acute cerebrovascular disease patients could walk. Subjects who did not have spasticity, who were taking antispasticity medicine, or had a previous episode of cerebrovascular disease were excluded. The walking speed of the patients was recorded before and after TENS. EMG examinations were performed on the healthy controls and in the affected side of the patients. A 30-minute single session of TENS was applied to lower extremity. At 10 minutes after TENS, the EMG examinations were repeated. [Results] A statistically significant decrease in the spasticity variables, and increased walking speed were found post-TENS. The lower M amplitude and higher H reflex amplitude, H/M maximum amplitude ratio, H slope, and H slope/M slope ratio on the spastic side were found to be statistically significant. [Conclusion] TENS application for hemiplegic patients with spastic lower extremities due to cerebrovascular disease resulted in marked improvement in clinical scales of spasticity and significant changes in the electrophysiological variables.

The combined effects of transcutaneous electrical nerve stimulation (TENS) and stretching on muscle hardness and pressure pain threshold

“…As for the combined usage of TENS and stretching, general clinical recommendations are as follows: stretching is applied after reducing pain by TENS in orthopedic disorders, and stretching is applied during or after electrically stimulating the antagonist of muscles displaying high levels of spasticity in central nervous system disorders 26 , 27 ) . However, the mechanisms of their effects have not been fully clarified.…”

<p>Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study</p>

“…It is possible TENS reduced both pain and PLMs through an overlapping enhancement of central inhibition and reduction in central excitation. Consistent with this hypothesis, several studies have demonstrated that TENS reduces the flexion reflex68,69 and spasticity 70–72. There is also preliminary evidence that TENS reduces symptoms of restless leg syndrome;73 however, that study did not measure PLMs.…”

Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis

“…Studies were included in the review if they (1) used a randomized controlled trial design, (2) involved stroke survivors, (3) used repetitive TENS/electrical somatosensory stimulation, (4) applied the stimulation to lower extremity and (5) included at least one outcome measure on lower extremity motor function. Studies were excluded if they (1) did not include a placebo or no-treatment control group, (2) investigated the effect of electroacupuncture, (3) did not report the central tendency and/or variability of the outcome of interest and (4) reported that the stimulation intensity was above motor threshold.…”

“…Previous studies have demonstrated that the application of transcutaneous electrical nerve stimulation (TENS) or somatosensory electrical stimulation to the paretic lower extremities of stroke survivors can reduce plantar flexor spasticity, [1][2][3][4][5][6][7] increase muscle strength 1,[7][8][9] and improve motor function. 3,4,6,8,10,11 The mechanisms behind motor recovery following the use of TENS include enhanced presynaptic inhibition of the hyperactive stretch reflexes in spastic muscles 1,2,12 and decreased cocontraction of the spastic antagonist muscles. 7 A previous meta-analysis conducted by Veerbeek et al 13 found a positive effect (Hedges' g = 0.56, 95% confidence interval (CI) = 0.27-0.84) in favour of TENS after pooling five randomized controlled trials that involved 195 stroke survivors.…”