IJPR.2020.169
Type of Article: Original Research
Volume 8; Issue 6 (November 2020)
Page No.: 3657-3662
DOI: https://dx.doi.org/10.16965/ijpr.2020.169
EFFECT OF COMBINING TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION WITH EXERCISE REGIME ON SPASTICITY AND UPPER EXTREMITY FUNCTION FOLLOWING CHRONIC MIDDLE CEREBRAL ARTERY STROKE
Srishti Banerjee *1, Mihirdev Jhala 2, Sadhana Mukhi 3.
*1 Assistant professor, L.J Institute of physiotherapy, L.J campus between sarkhej circle and kataria motors, S.G road, Ahmedabad, Gujarat, India.
2 Principal(IC), JG college of physiotherapy, JG campus of excellence, Sola road, Gulab tower, Thaltej Ahmedabad, Gujarat, India.
3 lecturer, JG college of physiotherapy , JG campus of excellence, Sola road , Gulab tower, Thaltej, Ahmedabad, Gujarat, India.
Address for Correspondence: Dr. Srishti Banerjee, PT Assistant professor, L.J Institute of physiotherapy, L.J campus between sarkhej circle and kataria motors, S.G road, Ahmedabad- 382210, Gujarat, India. E-Mail: srishtibanerjee5@gmail.com
ABSTRACT
Background: Post stoke hemiparesis limit the upper extremity function due to development of spasticity and synergy patterns, therefore rendering the patient impaired in activities of daily living. Transcutaneous electrical nerve stimulation (TENS) has recently been used to reduce spasticity. The purpose of this study was to evaluate the effects of TENS on spasticity and upper extremity function following chronic middle cerebral artery stroke (MCA).
Study design and setting: interventional study conducted on patients from clinical and hospital setting in Ahmedabad.
Methods: A total of 30 patients between the age group of 35-75 years of age. Group A received TENS for 30 minutes in addition to conventional exercise therapy regime where as group B received only exercise therapy regime. The intervention was given for 5 days a week for 4 weeks. The outcome measures were Modified Ashworth scale (MAS) and Fugl Meyer assessment for upper extremity (FMA-UE). The data collected was statistically analysed by using Wilcoxon’s signed rank test for within group analysis and Mann Whitney U test for between the group analysis.
Results and conclusion: Group A showed a statically (P <0.05) as well as clinically significant improvement in both the outcome measures. There-fore it was concluded that TENS prove to be effective in reducing spasticity and improving upper extremity function in chronic MCA stroke.
Key words: Stroke, Spasticity, TENS, Modified Ashworth scale (MAS), Fugl Meyer assessment for upper extremity (FMA-UE).
REFERENCES
[1]. Youngjeon Lee,Sang-Rae Lee,Sung S. Choi, Hyeon-Gu Yeo, Kyu-Tae Chang, and Hong J. Lee Therapeutically Targeting Neuroinflammation and Microglia after Acute Ischemic Stroke Hindawi Publishing Corporation. BioMed Research International Volume 2014, Article ID 297241.
https://doi.org/10.1155/2014/297241
PMid:25089266 PMCid:PMC4095830
[2]. Zandieh A, Kahaki ZZ, Sadeghian H, Fakhri M, Pourashraf M, Parviz S, Ghaffarpour M, Ghabaee M. A simple risk score for early ischemic stroke mortality derived from National Institutes of Health Stroke Scale: a discriminant analysis. Clinical neurology and neurosurgery. 2013 Jul 1;115(7):1036-9.
https://doi.org/10.1016/j.clineuro.2012.10.034
PMid:23219218
[3]. Neema Kanyal. The Science of Ischemic Stroke: Pathophysiology & Pharmacological Treatment International Journal of Pharma Research & Review, Oct 2015; 4(10):65-84.
[4]. Stoll G, Kleinschnitz C, Nieswandt B. Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment. Blood, The Journal of the American Society of Hematology. 2008 Nov 1;112(9):3555-62.
https://doi.org/10.1182/blood-2008-04-144758
PMid:18676880
[5]. Susan B Sullivan , Thomas J Schmitz : physical rehabilitation , 5th edition
[6]. Urban PP, Wolf T, Uebele M, Marx JJ, Vogt T, Stoeter P, Bauermann T, Weibrich C, Vucurevic GD, Schneider A, Wissel J. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke. 2010 Sep 1;41(9):2016-20.
https://doi.org/10.1161/STROKEAHA.110.581991
PMid:20705930
[7]. Dai C, Suresh NL, Suresh AK, Rymer WZ, Hu X. Altered motor unit discharge coherence in paretic muscles of stroke survivors. Frontiers in neurology. 2017 May 15;8:202.
https://doi.org/10.3389/fneur.2017.00202
PMid:28555126 PMCid:PMC5430034
[8]. Katz RT, Rymer WZ. Spastic hypertonia: mechanisms and measurement. Archives of physical medicine and rehabilitation. 1989 Feb 1;70(2):144-55.
[9]. Junhyuck Park, Dongkwon Seo, and Seungwon Lee The Effects of Exercise with TENS on Spasticity, Balance, and Gait in Patients with Chronic Stroke: A Randomized Controlled Trial Med Sci Monit, 2014; 20: 1890-1896.
https://doi.org/10.12659/MSM.890926
PMid:25300431 PMCid:PMC4206395
[10]. Levin MF, Hui-Chan CWY. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. ElectroencephalogrClinNeurophysiol. 1992;85:131-142.
https://doi.org/10.1016/0168-5597(92)90079-Q
[11]. Michele Tinazzi, Stefano Zarattini, Massimiliano Valeriani, Silvia Romito, Simona Farina, Giuseppe Moretto et al: Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: Evidence of reciprocal inhibition and facilitation. Exp Brain Res 2005;161.
https://doi.org/10.1007/s00221-004-2091-y
PMid:15551083
[12]. Tatsuya Mima, Tatsuhide Oga , John Rothwell, Takeshi Satow, Jun-ichi Yamamoto, Keiichiro Tom: Short-term highfrequency transcutaneous electrical nerve stimulation decreases human motor cortex excitability. Neurosci Lett 2004;355:85Y8.
https://doi.org/10.1016/j.neulet.2003.10.045
PMid:14729241
[13]. K-C Lin , C-Y Wu , T-H Wei , C-Y Lee, J-S Liu Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study. Clinical Rehabilitation, 21(12);1075-1086.
https://doi.org/10.1177/0269215507079843
PMid:18042603
[14]. Manoj Sivan, Rory J. O’Connor, Sophie Makower, Martin Levesley, Bipinchandra Bhakta, Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke J Rehabil Med 2011; 43: 181-189.
https://doi.org/10.2340/16501977-0674
PMid:21305232
[15]. Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Physical therapy. 1993 Jul 1;73(7):447-54.
https://doi.org/10.1093/ptj/73.7.447
PMid:8316578
[16]. Singer B, Garcia-Vega J. The Fugl-Meyer upper extremity scale. Journal of physiotherapy. 2017 Jan 1;63(1):53.
https://doi.org/10.1016/j.jphys.2016.08.010
PMid:27964964
[17]. Shaw L, Rodgers H, Price C, van Wijck F, Shackley P, Steen N, Barnes M, Ford G, Graham L. BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technol Assess. 2010 May 1;14(26):1-13.
https://doi.org/10.3310/hta14260
PMid:20515600
[18]. Manigandan G, Bharathi K. Effect of Transcutaneous Electrical Nerve Stimulation over Gastrocnemius Muscle Spasticity among Hemiparetic Patients. J Physiother Res. 2017;1(2):10.
[19]. Karakoyun A, Boyraz İ, Gunduz R, Karamercan A, Ozgirgin N. Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients. Journal of physical therapy science. 2015;27(11):3407-11.
https://doi.org/10.1589/jpts.27.3407
PMid:26696708 PMCid:PMC4681915
[20]. Aydin G, Tomruk S, Keles¸ I, O¨ zbudak s Demir Orkun S study on Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison Am J Phys Med Rehabil. 2005;Aug;8 4(8):584-92.
https://doi.org/10.1097/01.phm.0000171173.86312.69
PMid:16034227
[21]. Goulet C, Arsenault AB, Bourbonnais D, Laramée MT, Lepage Y. Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity.Scand J Rehabil Med. 1996 Sep;28(3):169-76.
[22]. Cho HY, In TS, Cho KH, Song CH. A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. The Tohoku journal of experimental medicine. 2013;229(3):187-93.
https://doi.org/10.1620/tjem.229.187
PMid:23419328
[23]. Ruth Dickstein , Yocheved Laufer, Miri Katz. TENS to the posterior aspect of the legs decreases postural sway during stance Neuroscience Letters 2006;393:51-55.
https://doi.org/10.1016/j.neulet.2005.09.039
PMid:16207512
