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Debeuf R, De Vlieger D, Defour A, Feyen K, Guida S, Cuypers L, Firouzi M, Tassenoy A, Swinnen E, Beckwée D, Leemans L. Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis. Disabil Rehabil 2024:1-17. [PMID: 38557249 DOI: 10.1080/09638288.2024.2334444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.
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Affiliation(s)
- Ruben Debeuf
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Daan De Vlieger
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Arne Defour
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Karen Feyen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefania Guida
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mahyar Firouzi
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Brain, Body and Cognition, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - An Tassenoy
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lynn Leemans
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Almutairi SM, Khalil ME, Almutairi N, Alsaadoon SM, Alharbi DS, Al Assadi SD, Alghamdi SF, Albattah SN, Alenazi AM. Effects of Neuromuscular Electrical Stimulation on Spasticity and Walking Performance among Individuals with Chronic Stroke: A Pilot Randomized Clinical Trial. Healthcare (Basel) 2023; 11:3137. [PMID: 38132027 PMCID: PMC10742606 DOI: 10.3390/healthcare11243137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Stroke and its associated complications are a major cause of long-term disability worldwide, with spasticity being a common and severe issue. Physical therapy, involving stretching exercises and electrical stimulation, is crucial for managing spasticity. Therefore, this study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) combined with a conventional rehabilitation program (CRP) on plantarflexor muscle spasticity and walking performance among individuals with chronic stroke. METHODS A pilot randomized clinical trial (RCT) with two groups (active NMES and placebo) was conducted at the physical therapy departments of King Fahad Specialist Hospital, Buraydah, and Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia (November 2020). The assessor and participants were blinded for the group assignment. The active NMES group received exercise and stimulation at the dorsiflexor muscles on the paretic leg for 30 min for 12 sessions. The placebo group received exercise and sham stimulation at the same position and duration as the active group. Of interest were the outcomes for plantarflexor muscle spasticity measured by the modified Ashworth scale (MAS), gait speed measured by 10 m walk test (10-MWT), and functional mobility measured by functional ambulatory category (FAC). RESULTS Nineteen participants were randomized into active NMES (n = 10) and sham NMES (n = 9) groups, with no significant baseline differences. Within the active NMES group, significant improvements were observed in MAS (p = 0.008), 10-MWT (p = 0.028), and FAC (p = 0.046), while only 10-MWT time improved significantly in the sham NMES group (p = 0.011). Between-group analysis showed that only MAS was significantly lower in the active NMES group (p = 0.006). Percent change analysis indicated a significantly higher increase in percent change for MAS in the active NMES group compared to the sham NMES group (p = 0.035), with no significant differences in other outcome measures. CONCLUSIONS This study showed that NMES in the active group led to significant improvements in spasticity, walking performance, and functional ambulation. Further research is needed to determine the ideal parameters, protocols, and patient selection criteria for NMES interventions in stroke rehabilitation.
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Affiliation(s)
- Sattam M. Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 52571, Saudi Arabia; (M.E.K.); (S.N.A.)
| | - Mohamed E. Khalil
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 52571, Saudi Arabia; (M.E.K.); (S.N.A.)
| | | | - Saud M. Alsaadoon
- Department of Rehabilitation Services and Programs, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571, Saudi Arabia; (S.M.A.); (D.S.A.); (S.D.A.A.); (S.F.A.)
| | - Dalal S. Alharbi
- Department of Rehabilitation Services and Programs, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571, Saudi Arabia; (S.M.A.); (D.S.A.); (S.D.A.A.); (S.F.A.)
| | - Sultan D. Al Assadi
- Department of Rehabilitation Services and Programs, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571, Saudi Arabia; (S.M.A.); (D.S.A.); (S.D.A.A.); (S.F.A.)
| | - Salem F. Alghamdi
- Department of Rehabilitation Services and Programs, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571, Saudi Arabia; (S.M.A.); (D.S.A.); (S.D.A.A.); (S.F.A.)
| | - Sahar N. Albattah
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 52571, Saudi Arabia; (M.E.K.); (S.N.A.)
| | - Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
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Aries AM, Downing P, Sim J, Hunter SM. Effectiveness of Somatosensory Stimulation for the Lower Limb and Foot to Improve Balance and Gait after Stroke: A Systematic Review. Brain Sci 2022; 12:brainsci12081102. [PMID: 36009165 PMCID: PMC9405913 DOI: 10.3390/brainsci12081102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
This systematic review’s purpose was to evaluate the effectiveness of lower-limb and foot somatosensory stimulation to improve balance and gait post-stroke. PRISMA reporting guidelines were followed. Included studies: randomized controlled trials (RCTs), published in English with ethical approval statement. Studies of conditions other than stroke, functional electrical stimulation, and interventions eliciting muscle contraction, were excluded. AgeLine, AMED, CINAHL PLUS, EMBASE, EMCARE MEDLINE, PEDro, PsycARTICLES, PsycINFO, SPORTDiscus, Web of Science and Cochrane central register of controlled trials were searched from 1 January 2002 to 31 March 2022. Two authors independently screened results, extracted data and assessed study quality using Cochrane Risk of Bias 2 tool; 16 RCTs (n = 638) were included. Four studies showed a medium or large standardized between-group effect size (Cohen’s d) in favor of somatosensory stimulation, in relation to: customized insoles (d = 0.527), taping (d = 0.687), and electrical stimulation (two studies: d = 0.690 and d = 1.984). Although limited by study quality and heterogeneity of interventions and outcomes, with only one study’s results statistically significant, several interventions showed potential for benefit, exceeding the minimally important difference for gait speed. Further research with larger trials is required. This unfunded systematic review was registered with PROSPERO (number CRD42022321199).
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Affiliation(s)
- Alison M. Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
- Correspondence: ; Tel.: +44-1782-734418
| | - Poppy Downing
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK
| | - Julius Sim
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK
| | - Susan M. Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK
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Immediate effects of transcutaneous electrical nerve stimulation on gait patterns in chronic stroke survivors: A single group, pretest-posttest clinical trial. Hum Mov Sci 2022; 83:102948. [DOI: 10.1016/j.humov.2022.102948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022]
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Molazadeh V, Zhang Q, Bao X, Sharma N. An Iterative Learning Controller for a Switched Cooperative Allocation Strategy during Sit-to-Stand Tasks with a Hybrid Exoskeleton. IEEE TRANSACTIONS ON CONTROL SYSTEMS TECHNOLOGY : A PUBLICATION OF THE IEEE CONTROL SYSTEMS SOCIETY 2022; 30:1021-1036. [PMID: 36249864 PMCID: PMC9560042 DOI: 10.1109/tcst.2021.3089885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A hybrid exoskeleton that combines functional electrical stimulation (FES) and a powered exoskeleton is an emerging technology for assisting people with mobility disorders. The cooperative use of FES and the exoskeleton allows active muscle contractions via FES while robustifying torque generation to reduce FES-induced muscle fatigue. In this paper, a switched distribution of allocation ratios between FES and electric motors in a closed-loop adaptive control design is explored for the first time. The new controller uses an iterative learning neural network (NN)-based control law to compensate for structured and unstructured parametric uncertainties in the hybrid exoskeleton model. A discrete Lyapunov-like stability analysis that uses a common energy function proves asymptotic stability for the switched system with iterative learning update laws. Five human participants, including a person with complete spinal cord injury, performed sit-to-stand tasks with the new controller. The experimental results showed that the synthesized controller, in a few iterations, reduced the root mean square error between desired positions and actual positions of the knee and hip joints by 46.20% and 53.34%, respectively. The sit-to-stand experimental results also show that the proposed NN-based iterative learning control (NNILC) approach can recover the asymptotically trajectory tracking performance despite the switching of allocation levels between FES and electric motor. Compared to a proportional-derivative controller and traditional iterative learning control, the findings showed that the new controller can potentially simplify the clinical implementation of the hybrid exoskeleton with minimal parameters tuning.
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Affiliation(s)
- Vahidreza Molazadeh
- Department of Mechanical Engineering and Materials Science at University of Pittsburgh, Pittsburgh, PA, USA
| | - Qiang Zhang
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina Chapel-Hill, Raleigh, NC, USA
| | - Xuefeng Bao
- Department of Biomedical Engineering at Case Western Reserve University, Cleveland, OH, USA
| | - Nitin Sharma
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina Chapel-Hill, Raleigh, NC, USA
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Sivertsen M, De Jaegher H, Arntzen EC, Alstadhaug KB, Normann B. Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1948. [PMID: 35306716 PMCID: PMC9539856 DOI: 10.1002/pri.1948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/20/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
Background and Purpose Physiotherapy, with an emphasis on high intensity, individually tailored, and person‐centered treatment, is an effective route for recovery after a stroke. No single approach, however, has been deemed paramount, and there is limited knowledge about the patient experience of assessment, goal‐setting, and treatment in physiotherapy. In this study, we seek to report patient experiences of I‐CoreDIST—a new physiotherapy intervention that targets recovery—and those of usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process. Methods A qualitative study, nested within a randomized controlled trial, consisting of in‐depth interviews with 19 stroke survivors who received either I‐CoreDIST or usual care. Data were analyzed using systematic text condensation, and this analysis was informed by enactive theory. Results Interaction with the physiotherapist, which was guided by perceived bodily changes, fluctuated between being, on the one hand, formal/explicit and, on the other, tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content of therapy sessions and the means of measuring progress; divergences in levels of satisfaction with the treatment were less pronounced. The perception of positive bodily changes, as well as the tailoring of difficulty and intensity, were common and essential features in generating meaning and motivation. An embodied approach seemed to facilitate sense‐making in therapy situations. In the interaction between the participants and their physiotherapists, trust and engagement were important but also multifaceted, involving both interpersonal skills and professional expertise. Conclusion The embodied nature of physiotherapy practice is a source for sense‐making and meaning‐construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.
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Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsoe, Norway.,Nordland Hospital Trust, Bodoe, Norway
| | - Hanne De Jaegher
- Department of Philosophy, University of the Basque Country, San Sebastián, Spain.,School of Psychology, University of Sussex, Brighton, UK
| | - Ellen Christin Arntzen
- Nordland Hospital Trust, Bodoe, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Karl Bjørnar Alstadhaug
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsoe, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Britt Normann
- Nordland Hospital Trust, Bodoe, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
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Kim H, Kim H, Shin WS. Effects of Vibrotactile Biofeedback Providing Real-Time Pressure Information on Static Balance Ability and Weight Distribution Symmetry Index in Patients with Chronic Stroke. Brain Sci 2022; 12:brainsci12030358. [PMID: 35326314 PMCID: PMC8946531 DOI: 10.3390/brainsci12030358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 12/10/2022] Open
Abstract
Training with visual and auditory biofeedback, in patients with stroke, improved balance ability and asymmetric posture. We developed a new biofeedback training device to prevent falls and improve balance ability in patients with stroke. This device corrects motion errors by collecting the pressure information of patients in real-time. This randomized crossover study aimed to investigate the effect of this biofeedback training on the static balance ability and weight distribution symmetry index in 24 patients with chronic stroke. Pressure sensor-based vibrotactile biofeedback, visual biofeedback providing posture information, and standing without biofeedback were randomly applied for 1 d each with 24 h washout intervals to minimize adaptation. The static balance ability was measured for each biofeedback training type, and the weight distribution symmetry index was calculated using the collected weight-bearing rate data. The static balance ability and weight distribution symmetry index differed significantly according to the type of biofeedback training used. Post-hoc analysis revealed significant differences in the order of newly developed vibrotactile biofeedback, visual biofeedback, and standing without biofeedback. These findings provide evidence that pressure sensor-based vibrotactile biofeedback improves static balance ability and weight support rates by proposing better intervention for patients with chronic stroke in the clinical environment.
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Affiliation(s)
- Ho Kim
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon 34520, Korea;
| | - Hongjun Kim
- Department of Computer Engineering, Daejeon University, Daejeon 34520, Korea;
| | - Won-Seob Shin
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon 34520, Korea
- Correspondence: ; Tel.: +82-42-280-2294
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Lee EL, Ko MH, Shin MJ, Lee BJ, Jung DH, Han KS, Kim JM. The Effect of Convergence Gamification Training in Community-Dwelling Older People: A Multicenter, Randomized Controlled Trial. J Am Med Dir Assoc 2022; 23:373-378.e3. [PMID: 34216552 DOI: 10.1016/j.jamda.2021.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES It is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement. DESIGN Randomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise. SETTING AND PARTICIPANTS 40 community-dwelling participants aged 60-85 years. METHOD Participants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest. RESULTS There were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test-30 seconds was scored as 3.60 ± 2.56 (P < .015); Five Times Sit to Stand Test-5 times, -1.75 ± 2.04 s (P < .015); Berg Balance Scale, 1.05 ± 1.39 (P < .015); Timed Up-and-Go test, -0.64 ± 0.64 s (P < .015); and 10-m Walking Test, -0.35 ± 0.47 s (P < .015). And in group 2, the mean Five Times Sit to Stand Test-30 seconds (s) was scored as 3.70 ± 2.62 (P < .015), Five Times Sit to Stand Test-5 times, -1.65 ± 1.59 s (P < .015); Berg Balance Scale, 1.05 ± 1.00 (P < .015); Timed Up-and-Go test, -0.93 ± 0.68 s (P < .015); 10-m Walking Test, -0.41 ± 0.489 s (P < .015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P < .015); and Korean version of the Falls Efficacy Scale-International, -1.05 ± 1.43 (P < .015). CONCLUSION AND IMPLICATIONS The results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.
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Affiliation(s)
- Eun-Lee Lee
- Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea; Department of Public health, Graduate School, Inje University, Pusan, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation of Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Myung-Jun Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea.
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Da Hwi Jung
- Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Kap-Soo Han
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jin Mi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
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Sobrinho ACDS, de Almeida ML, Rodrigues GDS, Bertani RF, Lima JGR, Bueno Junior CR. Stretching and Multicomponent Training to Functional Capacities of Older Women: A Randomized Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010027. [PMID: 35010287 PMCID: PMC8751009 DOI: 10.3390/ijerph19010027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE The real benefits of stretching when used as training for the older adult population and for developing other physical capacities are still uncertain. Thus, the objective of the present work is to investigate the effects of stretching training combined with multi-component training on the physical capacities of physically inactive older women. METHODS Women aged 60 to 70 years were randomized into three groups: multicomponent training (MT), multicomponent training combined with flexibility training (CT), and control group (CG). Both training interventions were carried out for 14 weeks, with two weekly sessions. Participants were assessed for agility, muscle strength (sitting and standing and elbow flexion/extension), and cardiorespiratory fitness (6-min walk). RESULTS AND DISCUSSION Multicomponent training with flexibility presented a very large effect on the variables of strength, agility, and aerobic fitness, while multicomponent training had a medium effect on agility and a large and very large effect on muscle strength variables. This is the first study in the literature to analyze the effect of flexibility training, associated with multicomponent training, on other physical capacities. CONCLUSIONS The results of the current study suggest that adding flexibility training to a multicomponent training program generates additional benefits to the development of other physical capacities.
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Affiliation(s)
- Andressa Crystine da Silva Sobrinho
- School of Medicine of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil; (A.C.d.S.S.); (G.d.S.R.); (J.G.R.L.)
| | - Mariana Luciano de Almeida
- College of Nursing of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil;
| | - Guilherme da Silva Rodrigues
- School of Medicine of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil; (A.C.d.S.S.); (G.d.S.R.); (J.G.R.L.)
| | - Rodrigo Fenner Bertani
- University of Franca (UNIFRAN), Avenida Dr. Armando de Sáles Oliveira 201, Franca 14404-600, SP, Brazil;
| | - Joao Gabriel Ribeiro Lima
- School of Medicine of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil; (A.C.d.S.S.); (G.d.S.R.); (J.G.R.L.)
| | - Carlos Roberto Bueno Junior
- School of Medicine of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil; (A.C.d.S.S.); (G.d.S.R.); (J.G.R.L.)
- College of Nursing of Ribeirao Preto, University of Sao Paulo (USP), Avenida Bandeirantes 3900, Ribeirao Preto 14049-900, SP, Brazil;
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Azharuddin M, Zia NU. Correlation between sit-to-stand ability, dynamic balance, gait speed, and quality of life in stroke population: a non-randomized pilot study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
“Sit to stand” being a prerequisite for walking, the inability of patients to perform it can result in institutionalization, impaired functioning and mobility in activities of daily living. There was a need to find out whether “sit to stand” ability correlates with gait speed, dynamic balance, and quality of life in stroke patients. It is a pilot study in which sixteen sub-acute and chronic stroke (˃ 6 months) patients aged 45 to 65 years with the ability to walk at least 10 m, Mini Mental State Examination (MMSE) score ˃ 27 were included. Patients with musculoskeletal impairments of lower extremity which would affect walking were excluded from the study. Each patient performed five times sit to stand (5TSTS) from a standard chair and time taken was recorded. Timed up and go (TUG) test and 10-m walk test (10MWT) were used to measure the dynamic balance and gait speed respectively. Stroke Adapted Sickness Impact Profile-30 (SASIP-30) scale was used to determine the quality of life of the patients.
Results
Correlation between the outcomes of the variables was analyzed using Pearson correlation co-efficient. The 5TSTS scores showed strong positive correlation to TUG (r = 0.823, P < .000) and SASIP-30 (r = 0.841, P < .000). However, moderately strong negative relationship was found between 5TSTS and gait speed (r = −0.639, P < .008).
Conclusion
The study concludes that change in the 5TSTS performance can affect motor functions like dynamic balance and gait as well as quality of life. Exercise training focusing on sit-to-stand ability may also influence activities of daily living (ADLs) after stroke.
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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12
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The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179351. [PMID: 34501940 PMCID: PMC8430807 DOI: 10.3390/ijerph18179351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. METHOD In this study, forty-eight participants aged 65-75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. RESULT After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions-front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only-front, back, and left (p < 0.05)-without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). CONCLUSION In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.
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Paillard T. Sensory electrical stimulation and postural balance: a comprehensive review. Eur J Appl Physiol 2021; 121:3261-3281. [PMID: 34351530 DOI: 10.1007/s00421-021-04767-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Sensory electrical stimulation (SES)-i.e., low-intensity electrical currents below, at, or just above the sensory threshold but below the motor threshold-is mainly used to restore/improve postural balance in pathological and healthy subjects. However, the ins and outs of its application as well as the neurophysiological effects induced are not yet well known. Hence, the aim of this paper was to address the effects of SES on postural balance based on these considerations. METHOD The immediate/concurrent effects (SES applied during postural balance measurements), the acute effects (SES durably applied before measuring postural balance) and the chronic effects (SES included in training/rehabilitation programs, i.e., measurements performed before and after the programs) were analysed with a comprehensive review. RESULT SES can lead to the improvement of postural balance using any of the three applications (immediate/concurrent, acute and chronic), notably in pathological subjects. The beneficial effects of SES can take place at the peripheral (sensory receptors sensitivity), spinal (spinal motoneural excitablity) and supra-spinal (cortex reorganisation or adaptation) levels. In healthy subjects, SES appears interesting, but too few studies have been conducted with this population to report clear results. Moreover, the literature is relatively devoid of comparative studies about the characteristics of the stimulation current (e.g., location, current parameters, duration). CONCLUSION In practice, SES appears to be particularly useful to reinforce or restore the postural function in the immediate/concurrent, acute or chronic application in pathlogical populations while its effects should be confirmed in healthy sujects by future studies. Moreover, future research should focus on the different characteristics of stimulation.
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Affiliation(s)
- Thierry Paillard
- Laboratoire Mouvement, Equilibre, Performance et Santé, EA 4445, Département STAPS, Université de Pau et des Pays de L'Adour/E2S, ZA Bastillac Sud, 65000, Tarbes, France.
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In TS, Jung JH, Jung KS, Cho HY. Effect of Sit-to-Stand Training Combined with Taping on Spasticity, Strength, Gait Speed and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. Life (Basel) 2021; 11:life11060511. [PMID: 34073094 PMCID: PMC8226448 DOI: 10.3390/life11060511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Spasticity is one of the factors that make it more difficult to control posture in stroke patients. Taping has been used to manage muscle stiffness in various musculoskeletal disorders. Recently, it has been used to decrease spasticity in stroke patients, but the effect of taping combined with therapeutic exercise is still unclear. The purpose of the present study was to determine whether the sit-to-stand (STS) training combined with taping improves the ankle spasticity, muscle strength, gait speed, and quality of life in stroke patients. Material and Methods: The study recruited 40 stroke patients, who were randomly divided into two groups: the taping and STS training (TSTS) group (n = 20) and the STS group (n = 20). The subjects in the TSTS group underwent STS training with Kinesio taping on the tibialis anterior, calf and ankle joint, whereas the subjects in the STS group underwent only STS training. All participants underwent 30 sessions of STS training (30 minutes, 5 days per week for 6 weeks). The present study evaluated the spasticity of ankle plantar flexors by the mean of the composite spasticity score; the muscle strength and gait speed were evaluated using the handheld dynamometer and the 10-meter walk test, respectively, and the quality of life was assessed using the stroke-specific quality of life scale. Result: The TSTS group and the STS group showed significant improvements in spasticity, muscle strength, walking speed, and quality of life after the intervention (p < 0.05). The level of improvement in the TSTS group was significantly higher in spasticity, muscle strength, and walking speed compared to the STS group (p < 0.05). Conclusions: The present study demonstrated that STS training is effective for decreasing spasticity in stroke patients and suggested that additional taping intervention further improved this effect. In addition, improvement of muscle strength and gait function was observed with a significant decrease of ankle spasticity.
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Affiliation(s)
- Tae-sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
| | - Jin-hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Korea;
| | - Kyoung-sim Jung
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
- Correspondence: (K.-s.J.); (H.-y.C.)
| | - Hwi-young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (K.-s.J.); (H.-y.C.)
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Bae Y. Standing Up from a Chair with an Asymmetrical Initial Foot Position Decreases Trunk and Masticatory Muscle Activities in Healthy Young Men. Healthcare (Basel) 2020; 8:healthcare8040480. [PMID: 33198353 PMCID: PMC7712816 DOI: 10.3390/healthcare8040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
This study aimed to identify the activation of lower extremity, trunk, and masticatory muscle and trunk kinematics of the initial foot position during the sit-to-stand (STS) movement. Sixteen young men participated in this cross-sectional pilot study and performed STS using both symmetrical and asymmetrical foot positions. Activation of the tibialis anterior (TA), gastrocnemius lateral head (GA), rectus femoris (RF), biceps femoris (BF), rectus abdominis, erector spinae (ES), sternocleidomastoid (SCM), upper trapezius (UT), temporalis (TE), and masseter muscles in the dominant side was determined. For trunk kinematics, head and trunk velocities, front-back (For-Back) and mediolateral (Med-Lat) weight translation rates, and trunk inclination were measured. GA, TA, BF, and RF activation significantly increased, whereas ES, SCM, UT, and TE activation significantly decreased when using the asymmetrical foot position. Head velocity, For-Back, Med-Lat, and trunk inclination were also significantly decreased. In conclusion, the asymmetrical foot position increases muscle activation in the lower extremities and decreases trunk inclination. In addition, ES, UT, and TE muscle activity decreases at the initial asymmetrical foot position.
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Affiliation(s)
- Youngsook Bae
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
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Wang CC, Chao JK, Wang ML, Yang YP, Chien CS, Lai WY, Yang YC, Chang YH, Chou CL, Kao CL. Care for Patients with Stroke During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke. J Stroke Cerebrovasc Dis 2020; 29:105182. [PMID: 33066878 PMCID: PMC7375317 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jian-Kang Chao
- Department of Social Work, National Pingtung University of Science & Technology, Pingtung, Taiwan; Department of psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Mong-Lien Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Ping Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Chien-Shiu Chien
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Wei-Yi Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university; Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan.
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Effectiveness of Heel-Raise-Lower Exercise after Transcutaneous Electrical Nerve Stimulation in Patients with Stroke: A Randomized Controlled Study. J Clin Med 2020; 9:jcm9113532. [PMID: 33142834 PMCID: PMC7692363 DOI: 10.3390/jcm9113532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was conducted to investigate the effect of the heel-raise-lower exercise on spasticity, strength, and gait speed after the application of 30 min of transcutaneous electrical nerve stimulation (TENS) in patients with stroke. METHODS The participants were randomly divided into the TENS group and the placebo group, with 20 participants assigned to each group. In the TENS group, heel-raise-lower exercise was performed after applying TENS for six weeks. The placebo group was trained in the same manner for the same amount of time but without electrical stimulation. The spasticity of the ankle plantar flexors was measured using the composite spasticity score. A handheld dynamometer and a 10-m walk test were used to evaluate muscle strength and gait speed, respectively. RESULTS Spasticity was significantly more improved in the TENS group (mean change -2.0 ± 1.1) than in the placebo group (mean change -0.4 ± 0.9) (p < 0.05). Similarly, muscle strength was significantly more improved in the TENS group (6.4 ± 3.3 kg) than in the placebo group (4.5 ± 1.6 kg) (p < 0.05). Moreover, participants assigned to the TENS group showed a significant greater improvement in gait speed than those in the placebo group (mean change -5.3 ± 1.4 s vs. -2.7 ± 1.2 s). CONCLUSIONS These findings show the benefits of heel-raise-lower exercise after TENS for functional recovery in patients with stroke.
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Abe S, Miyagi A, Yoshinaga K, Matsuka Y, Matsumoto F, Uyama E, Suzuki Y, Oshima M, Okura K, Tanaka E. Immediate Effect of Masticatory Muscle Activity with Transcutaneous Electrical Nerve Stimulation in Muscle Pain of Temporomandibular Disorders Patients. J Clin Med 2020; 9:jcm9103330. [PMID: 33081336 PMCID: PMC7603025 DOI: 10.3390/jcm9103330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/12/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a non-invasive treatment modality for acute and chronic pain. However, little information for muscle activity is available on the immediate effects of TENS in masticatory muscle pain related to temporomandibular disorders (TMDs). The present study aimed to evaluate the immediate effects of TENS treatment on TMD-related muscle pain. Thirty-six patients with TMD-related muscle pain and 39 healthy subjects served as TMD and control groups, respectively. For objective evaluations, maximum mouth opening, and maximum bite force were measured before and after TENS. The pain intensity was assessed according to a 100-mm visual analog scale (VAS). TENS was applied to painful muscles for 20 min with frequencies of 100–200 Hz. The treatment outcome was evaluated using Global Rating of Change (GRC) scales. In the TMD group, VAS values significantly decreased after TENS. Although there was significant increase in the maximum mouth opening after TENS for only TMD group, the maximum bite force of both groups was significantly greater after TENS. According to GRC scales, one patient with TMD-related muscle pain expressed negative feelings after TENS. Conclusively, TENS treatment might quickly relieve pain in masticatory muscles and improve masticatory functions in patients with TMD-related muscle pain.
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Affiliation(s)
- Susumu Abe
- Department of Comprehensive Dentistry, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan;
- Correspondence: ; Tel.: +81-88-633-9181
| | - Akane Miyagi
- Department of Comprehensive Dentistry, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan;
| | - Kaoru Yoshinaga
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (K.Y.); (E.T.)
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (Y.M.); (Y.S.); (M.O.); (K.O.)
| | - Fumihiro Matsumoto
- Department of Oral Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 7708504, Japan;
| | - Emi Uyama
- Department of Biomaterials and Bioengineering, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan;
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (Y.M.); (Y.S.); (M.O.); (K.O.)
| | - Masamitsu Oshima
- Department of Stomatognathic Function and Occlusal Reconstruction, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (Y.M.); (Y.S.); (M.O.); (K.O.)
| | - Kazuo Okura
- Department of Stomatognathic Function and Occlusal Reconstruction, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (Y.M.); (Y.S.); (M.O.); (K.O.)
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708504, Japan; (K.Y.); (E.T.)
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Bayle N, Maisonobe P, Raymond R, Balcaitiene J, Gracies JM. Composite active range of motion (CX A) and relationship with active function in upper and lower limb spastic paresis. Clin Rehabil 2020; 34:803-811. [PMID: 32336148 PMCID: PMC7263039 DOI: 10.1177/0269215520911970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate a novel composite measure of active range of motion (XA) and determine whether this measure correlates with active function. DESIGN Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA. SETTING Tertiary rehabilitation centers in Australia, Europe, and the United States. SUBJECTS Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma. INTERVENTIONS AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb. MAIN MEASURES XA was used to calculate a novel composite measure (CXA), defined as the sum of XA against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CXA and active function at Weeks 4 and 12 of open-label cycles were explored. RESULTS CXA and active function were moderately correlated in the upper limb (P < 0.0001-0.0004, r = 0.476-0.636) and weakly correlated in the lower limb (P < 0.0001-0.0284, r = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CXA and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CXA improvements peaked at Week 4, while functional improvements peaked at Week 12. CONCLUSION CXA is a valid measure for functional impairments in spastic paresis. CXA improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.
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Affiliation(s)
- Nicolas Bayle
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
| | | | | | | | - Jean-Michel Gracies
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
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Noh HJ, Kim CY, Kim HD, Kim SW. Changes in Muscle Activation and Ground Reaction Force of the Lower Limbs According to Foot Placement During Sit-to-Stand Training in Stroke Patients. Am J Phys Med Rehabil 2020; 99:330-337. [PMID: 32195716 DOI: 10.1097/phm.0000000000001335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to investigate the kinetic effects of sit-to-stand training in various foot positions on the coronal plane in patients with strokes and to suggest appropriate exercises. DESIGN Thirty-six poststroke subjects participated in this study. The subjects performed three sit-to-stand trials in the following foot positions: (a) symmetric foot positioning (symmetric), (b) affected foot placed to the side (asymmetric 1), and (c) and less affected foot placed to the side (asymmetric 2). They were asked to perform sit-to-stand training at a spontaneous velocity and remain standing for 5 secs, whereas the vertical ground reaction force was measured using force platforms. The activation of lower limb muscles was evaluated using surface electromyography, and the peak and mean vertical ground reaction force and weight-bearing symmetry ratio were evaluated using force platforms. RESULTS Our results showed significant increases in the muscle activation, peak and mean vertical ground reaction force, and weight-bearing symmetry ratio of the lower limbs using the asymmetric 2 strategy (P < 0.05). CONCLUSIONS Our results suggest that sit-to-stand training with the less affected foot placed to the side by the width of the subject's foot may be the most beneficial in the rehabilitation of patients with hemiparetic stroke.
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Affiliation(s)
- Hyeon-Je Noh
- From the Departments of Physical Therapy and School of Health and Environmental Science (H-JN, H-DK) and Health and Science (H-JN), College of Health Science, Korea University, Seoul; Scientific Instruments Reliability Assessment Center, Korea Basic Science Institute, Daejeon (C-YK); and Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul (S-WK), Republic of Korea
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Sun Y, Zehr EP. Sensory enhancement amplifies interlimb cutaneous reflexes in wrist extensor muscles. J Neurophysiol 2019; 122:2085-2094. [PMID: 31509473 DOI: 10.1152/jn.00324.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Interlimb neural connections support motor tasks such as locomotion and cross-education strength training. Somatosensory pathways that can be assessed with cutaneous reflex paradigms assist in subserving these connections. Many studies show that stimulation of cutaneous nerves elicits reflexes in muscles widespread across the body and induces neural plasticity after training. Sensory enhancement, such as long-duration trains of transcutaneous stimulation, facilitates performance during rehabilitation training or fatiguing motor tasks. Performance improvements due to sensory stimulation may be caused by altered spinal and corticospinal excitability. However, how enhanced sensory input regulates the excitability of interlimb cutaneous reflex pathways has not been studied. Our purpose was to investigate the effects of sensory enhancement on interlimb cutaneous reflexes in wrist extensor muscles. Stimulation to provide sensory enhancement (2-s trains at 150 Hz to median or superficial radial nerves) or evoke cutaneous reflexes (15-ms trains at 300 Hz to superficial radial nerve) was applied in different arms while participants (n = 13) performed graded isometric wrist extension. Wrist extensor electromyography and cutaneous reflexes were measured bilaterally. We found amplified inhibitory reflexes in the arm receiving superficial radial and median nerve sensory enhancement with net reflex amplitudes decreased by 709.5% and 695.3% repetitively. This suggests sensory input alters neuronal excitabilities in the interlimb cutaneous pathways. These findings have potential application in facilitating motor function recovery through alterations in spinal cord excitability enhancing sensory input during targeted rehabilitation and sports training.NEW & NOTEWORTHY We show that sensory enhancement increases excitability in interlimb cutaneous pathways and that these effects are not influenced by descending motor drive on the contralateral side. These findings confirm the role of sensory input and cutaneous pathways in regulating interlimb movements. In targeted motor function training or rehabilitation, sensory enhancement may be applied to facilitate outcomes.
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Affiliation(s)
- Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada.,Human Discovery Science, International Collaboration on Repair Discovery, Vancouver, British Columbia, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada.,Human Discovery Science, International Collaboration on Repair Discovery, Vancouver, British Columbia, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada.,Division of Medical Science, University of Victoria, Victoria, British Columbia, Canada.,Zanshin Consulting, Inc., Victoria, British Columbia, Canada
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Bhardwaj S, Khan AA, Muzammil M. Lower limb rehabilitation using multimodal measurement of sit-to-stand and stand-to-sit task. Disabil Rehabil Assist Technol 2019; 16:438-445. [PMID: 31288589 DOI: 10.1080/17483107.2019.1629701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Assistive and rehabilitation devices are dependent upon detecting the user intent through physiological and kinematics changes. Rising from a chair and vice-versa have been less investigated for the purpose of rehabilitation-aids. This study investigates the muscle activation along with trunk and knee biomechanics in sagittal plane during sit-to-stand and stand-to-sit transfer. METHOD Nine healthy participants (age 25.67 ± 3.27 years) were measured for flexion/extension of knee and trunk, and for surface electromyography (EMG) of vastus lateralis (VL) and biceps femoris (BF) of both the legs at a speed of 100 beats per minute while performing sit-to-stand and stand-to-sit task. RESULTS The knee flexion angles at peak EMG-RMS (root mean square envelope of EMG) were significantly different for the two tasks (p = 0.002). Also, for each muscle, EMG-RMS peak was obtained at significantly different knee angle within the same task (p = 0.046). EMG work done (WD) was also found to be significantly different for the intervened muscles (p = 0.002). CONCLUSIONS Trunk flexion together with VL showed an earlier onset in sit-to-stand task, which might form an important modality for detecting human intention to perform the activity. However, for stand-to-sit task, some other muscle group in conjunction to BF may be useful for detecting the human intention. The understanding from the study could be used as a first step in devising multimodal control for assistive devices aiding sit-to-stand and stand-to-sit transfers. That would be a novel approach to fuse the data of postural deviation into the EMG signal to achieve lower limb rehabilitation or in prosthetic control.Implications for rehabilitationMulti-modal sensor fusion can be used for realtime monitoring of patient biomechanics.Development of control algorithms for assistive devices aiding sit-stand transfers.Sensor fusion will help in achieving greater robotic compliance rehabilitation.
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Affiliation(s)
- Siddharth Bhardwaj
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Abid Ali Khan
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Muzammil
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Serrada I, Hordacre B, Hillier SL. Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:402. [PMID: 31114472 PMCID: PMC6503047 DOI: 10.3389/fnins.2019.00402] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life. Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity, indicating a potential mechanism which may mediate recovery. However, rehabilitation specifically focusing on somatosensory function receives little attention. Objectives: To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke. Methods: Electronic databases and trial registries were searched from inception until November 2018, in addition to hand searching systematic reviews. Study selection included randomized controlled trials for adults of any stroke type with an upper and/or lower limb sensorimotor impairment. Participants all received a sensory-based intervention designed to improve activity levels or impairment, which could be compared with usual care, sham, or another intervention. The primary outcomes were change in activity levels related to sensorimotor function. Secondary outcomes were measures of impairment, participation or quality of life. Results: A total of 38 study trials were included (n = 1,093 participants); 29 explored passive sensory training (somatosensory; peripheral nerve; afferent; thermal; sensory amplitude electrical stimulation), 6 active (sensory discrimination; perceptual learning; sensory retraining) and 3 hybrid (haptic-based augmented reality; sensory-based feedback devices). Meta-analyses (13 comparisons; 385 participants) demonstrated a moderate effect in favor of passive sensory training on improving a range of upper and lower limb activity measures following stroke. Narrative syntheses were completed for studies unable to be pooled due to heterogeneity of measures or insufficient data, evidence for active sensory training is limited however does show promise in improving sensorimotor function following stroke. Conclusions: Findings from the meta-analyses and single studies highlight some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, evidence for active sensory training continues to be limited. Further high-quality research with rigorous methods (adequately powered with consistent outcome measures) is required to determine the effectiveness of sensory retraining in stroke rehabilitation, particularly for active sensory training.
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Affiliation(s)
- Ines Serrada
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Susan L Hillier
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Mahmood A, Veluswamy SK, Hombali A, Mullick A, N M, Solomon JM. Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:751-768. [DOI: 10.1016/j.apmr.2018.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
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Alhusaini AA, Fallatah S, Melam GR, Buragadda S. Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy. Somatosens Mot Res 2019; 36:49-55. [PMID: 30913943 DOI: 10.1080/08990220.2019.1584555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP). MATERIALS AND METHODS Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy. RESULTS The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group. CONCLUSIONS The use of TENS in combination with therapeutic exercise may improve strength and hand function.
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Affiliation(s)
- Adel A Alhusaini
- a The Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
| | - Saber Fallatah
- b Rehabilitation Department , Medical Rehabilitation Hospital , Riyadh , Saudi Arabia
| | - Ganeswara Rao Melam
- c Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
| | - Syamala Buragadda
- c Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
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26
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Marcolino MAZ, Hauck M, Stein C, Schardong J, Pagnussat ADS, Plentz RDM. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2018; 42:623-635. [PMID: 30326752 DOI: 10.1080/09638288.2018.1503736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration's risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (-0.52 [-0.74 to -0.30] p < 0.0001, 6 studies), especially in lower limbs (-0.58 [-0.82 to -0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.Implications for RehabilitationTranscutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.
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Affiliation(s)
- Miriam Allein Zago Marcolino
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Melina Hauck
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cinara Stein
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jociane Schardong
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Aline de Souza Pagnussat
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rodrigo Della Méa Plentz
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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27
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Schröder J, Truijen S, Van Criekinge T, Saeys W. Peripheral somatosensory stimulation and postural recovery after stroke - a systematic review. Top Stroke Rehabil 2018; 25:312-320. [PMID: 29473456 DOI: 10.1080/10749357.2018.1440694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose It is hypothesized that peripheral somatosensory stimulation (PSS) can promote postural recovery after stroke by increasing afferent input and postural contribution of the paretic leg. Therefore, this systematic review aims to investigate which PSS approaches are documented and investigated on effectiveness. Methods Five databases (PubMed, Web of Science, PEDro, Cochrane Library Trials, RehabData) have been searched on clinical studies in stroke rehabilitation, investigating PSS, which is defined as a non-motor and focal stimulation to the paretic leg aiming an increase in somatosensory input. Results Twenty studies present different PSS approaches (mainly electrical and vibration stimulation) and following results: (I) There is an immediate effect after a single session of PSS on postural stability. In contrast, (II) repetitive sessions of isolated PSS led to highly inconsistent results. Finally, (III) PSS as an adjuvant to exercises did promote long-term postural recovery. Conclusion PSS is found to be effective immediately and on a long-term as an adjuvant therapy only in improving postural stability in a chronic stroke population. However, if PSS enhances paretic leg postural contribution remains unclear. Future research is warranted considering promising results and high prevalence of postural instability impacting daily life of stroke survivors.
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Affiliation(s)
- Jonas Schröder
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp , Antwerp , Belgium
| | - Steven Truijen
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp , Antwerp , Belgium
| | - Tamaya Van Criekinge
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp , Antwerp , Belgium
| | - Wim Saeys
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp , Antwerp , Belgium
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Kwong PWH, Ng GYF, Chung RCK, Ng SSM. Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower-Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial. J Am Heart Assoc 2018; 7:e007341. [PMID: 29437598 PMCID: PMC5850185 DOI: 10.1161/jaha.117.007341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/10/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcutaneous 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 RESULTS Eighty 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. CONCLUSIONS The 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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Affiliation(s)
- Patrick W H Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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29
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Kwong PW, Ng GY, Chung RC, Ng SS. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. Clin Rehabil 2017; 32:1203-1219. [PMID: 29232981 DOI: 10.1177/0269215517745349] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS. REVIEW METHODS A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance. RESULTS In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges' g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges' g = -0.884; 95% CI = -1.140 to -0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges' g = 0.468; 95% CI = 0.201-0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges' g = 0.254; 95% CI = -0.106-0.614). CONCLUSION The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.
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Affiliation(s)
- Patrick Wh Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Gabriel Yf Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Raymond Ck Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shamay Sm Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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30
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Kim JH, Cho YS, Park JS, Kim WJ. Effect of motor imagery training and electromyogram-triggered neuromuscular electrical stimulation on lower extremity function in stroke patients: a pilot trial. J Phys Ther Sci 2017; 29:1931-1933. [PMID: 29200627 PMCID: PMC5702817 DOI: 10.1589/jpts.29.1931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of motor imagery training and
electromyogram-triggered neuromuscular electrical stimulation (MIT-EMG NMES) on the lower
extremity function of stroke patients. [Subjects and Methods] This study recruited eight
patients with hemiplegia due to stroke. All patients received MIT-EMG NMES for 20 min
daily, 5 days per week for 4 weeks. Lower extremity function were assessed using the timed
up-and-go (TUG) and 10-meter walk (10MW) tests. [Results] The results of TUG test
decreased significantly from 20.5 ± 4.5 to 14.0 ± 3.5 s, while those of 10 MW test showed
a significant decrease from 21.3 ± 4.5 to 15.5 ± 3.2 m. [Conclusion] This study suggests
that MIT-EMG NMES is a new rehabilitation therapy for lower extremity recovery in
hemiplegic stroke patients.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Occupational Therapy, Gimcheon University, Republic of Korea
| | - Young-Seok Cho
- Department of Occupational Therapy, Hyejeon College, Republic of Korea
| | - Ji-Su Park
- Department of Rehabilitation Science, Graduate School of Inje University, Republic of Korea
| | - Won-Jin Kim
- Department of Occupational Therapy, Kosin University: 194 Wachi-ro, Yeongdo-gu, Busan, Republic of Korea
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