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

Abstract

Severe upper limb paresis is a major contributor to disability after stroke. This study investigated the efficacy of task-related training (TRT) with transcutaneous electrical nerve stimulation (TENS) on recovery of upper limb motor function in chronic-stroke survivors. Thirty patients with chronic stroke were randomly allocated two groups: the TRT+TENS group (n = 15) and the TRT+placebo (TRT+PLBO) group (n = 15). Patients in the TRT+TENS group received TENS stimulation (two to three times the sensory threshold), while subjects in the TRT+PLBO group received TENS without real electrical stimulation. TENS was applied to muscle belly of triceps and wrist extensors, while placebo (PLBO) stimulation was administrated without real electrical stimulation. Both interventions were given for 30 minutes per day, 5 days per week, for a period of 4 weeks. The primary outcomes were assessed with Fugl-Meyer assessment scores (FMA), Manual function test (MFT), Box and block test (BBT), and Modified Ashworth scale (MAS), each of which was performed one day before and one day after intervention. Both groups showed significant improvements in FMA, MFT, and BBT after intervention. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvements in FMA (p = 0.034), MFT (p = 0.037), and BBT (p = 0.042). In MAS score, significant improvement was observed only in the TRT+TENS group (p = 0.011). Our findings indicate that TRT with TENS can reduce motor impairment and improve motor activity in stroke survivors with chronic upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke

“…7 In addition, randomized controlled trials showing that PNS can enhance outcomes of task-oriented training have primarily targeted only mild-to-moderate UE impairment. [16][17][18][19] In sum, although pairing PNS with motor training can enhance motor recovery after stroke, it remains unclear how severity of motor deficit may affect responsiveness to this paired intervention.…”

“…7 In addition, randomized controlled trials showing that PNS can enhance outcomes of task-oriented training have primarily targeted only mild-to-moderate UE impairment. [16][17][18][19] In sum, although pairing PNS with motor training can enhance motor recovery after stroke, it remains unclear how severity of motor deficit may affect responsiveness to this paired intervention.14 To address these evidence gaps, the purpose of this study was to investigate whether active PNS paired with intensive task-oriented training would lead to significantly more improved movement function than sham PNS paired with intensive task-oriented training for subjects with chronic, severe deficit in UE movement function after stroke. …”

Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: A systematic review and meta-analysis

“…A total of 923 publications was identified through the initial search of databases. Ultimately, 7 RCTs were included in the meta-analysis (11)(12)(13)(14)(15)(16)21).…”

“…Post-stroke time varied from several days to several years. Among the 7 RCTs, 3 studies reported the MAS (11,12,16), 2 studies reported the Timed Up and Go test (12,13), 1 study reported the balance (open eyes) and balance (closed eyes) (12), and 3 studies reported eyes), balance (closed eyes), and walking speed. The study author was contacted to acquire data when necessary.…”

“…In contrast to this promising finding, however, some relevant randomized controlled trials (RCTs) have shown that TENS does not reduce spasticity and increase walking speed (14)(15)(16). Considering these inconsistent effects, we therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the influence of TENS on spasticity, balance, and walking speed of stroke patients.…”