Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions

Levin, Mindy F.; Hui-Chan, C.W.Y.

doi:10.1016/0168-5597(92)90079-q

Cited by 248 publications

(175 citation statements)

References 21 publications

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“…A sensory score of 224 defines normal sensation, whereas a maximum value of 100 can be reached for the motor score. The spasticity index 16 measured the Achilles tendon reflex, the passive resistance to dorsiflexion and the amount and duration of the clonus at the ankle. The total spasticity index score ranges from 0 (no spasticity) to 16 (severe spasticity).…”

Section: Clinical Evaluationmentioning

confidence: 99%

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

Gagnon¹,

Nadeau²,

Gravel³

et al. 2004

Spinal Cord

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Study design: Three-dimensional kinematic analysis and surface electromyography (EMG) of 10 male adults with complete spinal cord injury (C7 to L2). Objective: To examine movement patterns and muscular demands in individuals with spinal cord injury (SCI) during posterior transfers. Setting: Pathokinesiology Laboratory at a Rehabilitation Centre, Montreal, Canada. Methods: Kinematic variables that described the positions and angular displacements of the head, trunk, shoulder and elbow were obtained by videotaping markers placed on the subject segments. EMG data were recorded for the biceps, triceps, anterior deltoid, pectoralis major, latissimus dorsi and trapezius muscles of the dominant upper extremity during posterior transfers using surface electrodes. To quantify the muscular demand, the EMG data recorded during the transfers were normalized to values obtained during maximal static contractions (EMGmax). The mean muscular demand was calculated for every muscle during the lift phase of the transfers. The lift phase was determined by pressure-sensitive contacts. Results: All subjects were able to execute the posterior transfers on an even surface, whereas nine subjects completed at least one of the transfers to the elevated surface. A forward-flexion pattern at the head and trunk was observed when either one or two hands remained on the lower surface, whereas a lift strategy was seen when both hands were placed on the elevated surface. Transferring to the elevated surface with hands on the lower surface required inferior electromyographic muscular utilization ratio (EMUR) than the transfer on the even surface for all muscles. The lowest EMUR were calculated for the transfer to the elevated surface with hands on the lower surface (triceps (18%), pectoralis major (53.8%), trapezius (66%) and latissimus dorsi (24.5%)) while performing the same transfer with hands on the elevated surface generated the highest EMUR (triceps (40.2%), anterior deltoid (73.2%), trapezius (83.6%) and latissimus dorsi (55.3%)). Conclusions: Subjects presented different movement characteristics and muscular demands during the posterior transfers. It is suggested that the forward-flexion pattern improves the dynamic trunk stability and reduces the muscular demand required to transfer. High muscular demand developed when hands were positioned on the elevated surface might be due to increased postural control demands on the upper limb and reduced angular momentum.Spinal Cord (2005) 43, 74-84.

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Section: Clinical Evaluationmentioning

confidence: 99%

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

Gagnon¹,

Nadeau²,

Gravel³

et al. 2004

Spinal Cord

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“…TENS improved motor function by increasing voluntary contraction and reducing spinal reflex, which controlled cocontraction of agonists-antagonists in hemiplegic patients 28) , and high-frequency electrical stimulation increased stepping force in animal study as well 29) . TENS stimulation on gastrocnemius increased H-reflex amplitude, the parameter for spinal motor neuron excitability 30) .…”

Section: Gribbles Et Al Reported Mf In the Lower Limbs Increasedmentioning

confidence: 99%

Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Changes in Postural Balance and Muscle Contraction following Muscle Fatigue

Cho

Lee

et al. 2011

J Phys Ther Sci

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Abstract.[Purpose] The purpose of this study was to investigate the effects of transcutaneous electrical stimulation (TENS) applied to fatigued muscles on postural imbalance and decline in muscle strength following fatigue of the gastrocnemius.[Subjects] Eighteen subjects with muscle fatigue were allocated to either a sensory threshold group or a 2~3 times sensory threshold group and the study followed a randomized single-blind cross-over design.[Methods] Muscle fatigue of the gastrocnemius was induced by repeated exercise. After inducing fatigue, TENS was applied to the fatigued muscle. The postural sway length (PSL), postural sway velocity (PSV) and maximal voluntary contraction (MVC) were measured before and after the induction of fatigue, and during the application of TENS to the fatigued muscles.[Results] Muscle fatigue increased postural imbalance as expressed by length and velocity of body sway and decreased muscle strength, while TENS improved the postural imbalance and partially reversed the muscle strength decline induced by muscle fatigue.[Conclusion] Muscle fatigue is an important factor in postural balance control and muscle voluntary contraction, and TENS can be effective at relieving muscle fatigue.

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“…The mechanism that underlies the improved motor function in paretic limbs after TENS treatment is multifactorial; it involves alleviation of the hyperexcitability of alpha motor neurons,9, 11 reduction of intracortical inhibition,12 and enhancement of corticomuscular functional connectivity 13. Several clinical studies have demonstrated that the hyperexcitability of the alpha motor neurons that innervate the spastic ankle plantarflexor could be reduced by an increase in presynaptic inhibition after repetitive TENS 9, 11. Levin and Huichan reported that the ankle plantarflexor stretch reflex amplitude, as measured by the magnitude of integrated electromyography, was reduced significantly after a 3‐week regimen of repetitive TENS over the common peroneal nerve but not after placebo‐TENS stimulation 9.…”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic effects of TENS may be mediated via peripheral9, 10, 11 and central mechanisms 12, 13. At the peripheral level, TENS applied over paretic legs reduced the amplitude of the H‐reflex9 and lengthened the stretch reflex latency10 and H‐reflex latency11 in subjects with chronic stroke.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

Kwong

Chung

et al. 2018

JAHA

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BackgroundTranscutaneous electrical nerve stimulation (TENS) has been used to augment the efficacy of task‐oriented training (TOT) after stroke. Bilateral intervention approaches have also been shown to be effective in augmenting motor function after stroke. The purpose of this study was to compare the efficacy of bilateral TENS combined with TOT versus unilateral TENS combined with TOT in improving lower‐limb motor function in subjects with chronic stroke.Methods and ResultsEighty subjects were randomly assigned to bilateral TENS+TOT or to unilateral TENS+TOT and underwent 20 sessions of training over a 10‐week period. The outcome measures included the maximal strength of the lower‐limb muscles and the results of the Lower Extremity Motor Coordination Test, Berg Balance Scale, Step Test, and Timed Up and Go test. Each participant was assessed at baseline, after 10 and 20 sessions of training and 3 months after the cessation of training. The subjects in the bilateral TENS+TOT group showed greater improvement in paretic ankle dorsiflexion strength (β=1.32; P=0.032) and in the completion time for the Timed Up and Go test (β=−1.54; P=0.004) than those in the unilateral TENS+TOT group. However, there were no significant between‐group differences for other outcome measures.ConclusionsThe application of bilateral TENS over the common peroneal nerve combined with TOT was superior to the application of unilateral TENS combined with TOT in improving paretic ankle dorsiflexion strength after 10 sessions of training and in improving the completion time for the Timed Up and Go test after 20 sessions of training.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02152813.

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Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions

Cited by 248 publications

References 21 publications

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Changes in Postural Balance and Muscle Contraction following Muscle Fatigue

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

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