Balance trainer training with transcutaneous electrical nerve stimulation improves spasticity and balance in persons with chronic stroke

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study was determine the effect of Balance Trainer training with Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity and balance in persons with chronic stroke.
Design: Randomized controlled trial.
Methods: A total of 30 subjects with hemiparetic stroke were recruited and randomly divided into the Balance Trainer training with TENS group (n=15) and Balance Trainer training with placebo TENS group (n=15). The Balance Trainer training with TENS group practiced additional Balance Trainer training with TENS for 30 minutes a day, 5 days per a week during 4 weeks and the Balance Trainer training with placebo TENS group practiced additional Balance Trainer training with placebo TENS for the same period. Spasticity and balance were assessed by ability (static balance, dynamic balance) and were measured before and after the 4-week programs.
Results: The result of spasticity and dynamic balance were improved significantly in both groups (p<0.05). The Balance Trainer training with TENS group showed significantly greater improvement in spasticity of the gastrocnemius & dynamic balance, compared to the Balance Trainer training with placebo TENS group (p<0.05). The Balance trainer training with TENS group showed a significant improvement in static balance, especially during the eye-closed condition (p<0.05).
Conclusions: The Balance Trainer training with TENS was effective in improving spasticity and balance in subjects with chronic stroke. Based on these results, it is suggested that Balance Trainer training with TENS could clinically be used more actively in conjunction with conventional physical therapy.

참고문헌 (Reference)

1 Walker C, "Use of visual feedback in retraining balance following acute stroke" 80 : 886-895, 2000

2 Whitney SL, "The sensitivity and specificity of the Timed “Up & Go” and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders" 14 : 397-409, 2004

3 Park J, "The effects of exercise with TENS on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial" 20 : 1890-1896, 2014

4 Yavuzer G, "The effects of balance training on gait late after stroke : a randomized controlled trial" 20 : 960-969, 2006

5 Kim TH, "Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke" 231 : 93-100, 2013

6 O’Dwyer NJ, "Spasticity and muscle contracture following stroke" 119 (119): 1737-1749, 1996

7 Thibaut A, "Spasticity after stroke: physiology, assessment and treatment" 27 : 1093-1105, 2013

8 Dietz V, "Spastic movement disorder : impaired reflex function and altered muscle mechanics" 6 : 725-733, 2007

9 Sheean G, "Spastic hypertonia and movement disorders:pathophysiology, clinical presentation, and quantification" 1 : 827-833, 2009

10 Mima T, "Short-term high-frequency transcutaneous electrical nerve stimulation decreases human motor cortex excitability" 355 : 85-88, 2004

11 Bütefisch C, "Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand" 130 : 59-68, 1995

12 Gregson JM, "Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity" 80 : 1013-1016, 1999

13 Maeda Y, "Release of GABA and activation of GABA(A)in the spinal cord mediates the effects of TENS in rats" 1136 : 43-50, 2007

14 Doan QV, "Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity" 4 : 4-10, 2012

15 John LT, "Postural control and fear of falling in persons with low-level paraplegia" 47 : 497-502, 2010

16 Matjacić Z, "Methods for dynamic balance training during standing and stepping" 29 : 462-466, 2005

17 Lord SE, "Measurement of community ambulation after stroke : current status and future developments" 36 : 1457-1461, 2005

18 Tinazzi M, "Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation(TENS)of forearm muscles : evidence of reciprocal inhibition and facilitation" 161 : 457-464, 2005

19 Carr JH, "Investigation of a new motor assessment scale for stroke patients" 65 : 175-180, 1985

20 Goljar N, "Improving balance in subacute stroke patients : a randomized controlled study" 33 : 205-210, 2010

21 Martins FL, "Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects : a randomized crossover trial" 16 : 337-344, 2012

22 Duncan PW, "Functional reach : a new clinical measure of balance" 45 : M192-M197, 1990

23 Wu CW, "Enduring representational plasticity after somatosensory stimulation" 27 : 872-884, 2005

24 Jung KS, "Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study" 54 : 183-187, 2017

25 Cheng JS, "Effects of combining electric stimulation with active ankle dorsiflexion while standing on a rocker board : a pilot study for subjects with spastic foot after stroke" 91 : 505-512, 2010

26 Chan KS, "Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke : a randomized controlled trial" 26 : 1087-1095, 2012

27 Sibley KM, "Balance assessment practices and use of standardized balance measures among Ontario physical therapists" 91 : 1583-1591, 2011

28 Rydahl SJ, "Ankle stiffness and tissue compliance in stroke survivors : a validation of Myotonometer measurements" 85 : 1631-1637, 2004

29 Cho HY, "A single trial of transcutaneous electrical nerve stimulation(TENS)improves spasticity and balance in patients with chronic stroke" 229 : 187-193, 2013