Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial (original) (raw)
Related papers
2013
Background: There is increasing evidence of neural plastic changes associated with specific training that is goal-directed and requires special attention with practice. Sensory input by Transcutaneous electrical stimulation (TENS) on acupoints and task related training (TRT) induces recovery of lower limb function in patients after stroke. There are very few studies which show the effectiveness and importance of sensory stimulation through acupoints, therefore the purpose of the current study is to evaluate the effectiveness of TENS on acupoints when applied with other rehabilitation program on reducing spasticity and improving lower limb function in subjects after sub-acute stroke. Materials and Methods: Thirty subjects with sub-acute stroke of either side including both male and female participated in randomised clinical trial. Both group received TRT along with conventional physiotherapy program. TENS on acupoints was given in subjects of experimental group along with TRT and con...
The Medical Journal of Cairo University, 2019
Background: Stroke is the leading cause of long-term disability; the restoration of movements and associated functions is a common concern of stroke patients. However, the restoration of the upper limb function is often poor, being seen in less than half of patients. Electrical stimulation is shown to be effective in enhancing the upper extremity functional recovery in stroke patients. Aim of Study: To determine the effect of acupuncture TENS on upper limb function in stroke patients. Procedures: This study was conducted on thirty male stroke patients. Patients were randomly assigned into two equal groups: The study group (GI) and the control group (GII). Group I (study group): This group received acupuncture (TENS) in addition to the selected physical therapy program. Group II (control group): This group received the selected physical therapy program only. Fugel-Meyer Scale was used to assess the upper limb function and Modified Ashworth scale (MAS) was used to assess the spasticity grades before and after four weeks of the treatment program. Results: The results showed that: There was a significant difference of Fugel-Meyer Scale scores and mean values of spasticity grades in study group after the designed treatment program. Conclusion: The acupuncture Transcutaneous Electrical Nerve Stimulation (TENS) has a significant effect in reduction of spasticity and improvement of upper extremity function following stroke.
Stroke, 2010
Background and Purpose-The purpose of our study was to investigate the effects of different doses of neuromuscular electrical stimulation (NMES) on upper-extremity function in acute stroke patients with severe motor deficit. Methods-Sixty-six acute stroke patients were randomized to 3 groups: high NMES, low NMES, or control. The low-NMES group received 30 minutes of stimulation per day, and the high-NMES group received 60 minutes per day, for 4 weeks. The Fugl-Meyer Motor Assessment Scale, Action Research Arm Test, and Motor Activity Log were used to assess the patients at baseline, 4 weeks, and 12 weeks post baseline (follow-up). Results-Both NMES groups showed significant improvement on Fugl-Meyer Motor Assessment and Action Research Arm Test scales compared with the control group at week 4 and follow-up. The high-NMES group showed treatment effects similar to those of the low-NMES group. Conclusions-Higher and lower doses of NMES led to similar improvements in motor function. A minimum of 10 hours of NMES in combination with regular rehabilitation may improve recovery of arm function in stroke patients during the acute stage. (Stroke. 2010;41:821-824.
Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation
Background and Purpose-In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation. Methods-In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up.
Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke
Clinical Rehabilitation, 2002
Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke. Subjects and setting: Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation. Thirty-two received active treatment in the paretic hand and eight received no-current placebo treatment in the paretic hand. Nineteen patients received active stimulation of the paretic foot. None received stimulation in both upper and lower limbs. Intervention: Cutaneous stimulation was delivered twice daily via a special glove/sock electrode. Main outcome measures: Modi ed Motor Assessment Scale, 10-metre walking test, paretic limb function, limb skin sensation and somatosensor y evoked potentials (SEP) were performed before and after the treatment. Results: Modi ed Motor Assessment Scale (p < 0.001), 10-metre walking test (p < 0.05), paretic hand function (p < 0.01), upper limb skin sensation (p < 0.01) and SEP normality classi cation of paretic upper limb (p < 0.01) and paretic lower limb (p < 0.5) improved signi cantly in the treatment group (n = 51) after three weeks of stimulation. When active hand treatment and placebo hand treatment were compared, a signi cant improvement in the sensory and motor function was observed only in the actively treated group. Conclusions: Cutaneous stimulation had positive effects in the motor performance, limb sensation and the con guration of SEP of the paretic limb in chronic stroke patients.
Journal of Rehabilitation Medicine, 2012
To investigate the predictors related to upper extremity functional recovery, with special emphasis on neuromuscular electrical stimulation dose-response in patients after stroke. Subjects: Ninety-five patients with stroke who received a 4-week neuromuscular electrical stimulation intervention. Design: Prospective predictive analysis. Methods: The change score of the Action Research Arm Test (ARAT) was used as the main outcome. Baseline subject characteristics, stroke-related data, and intervention-related data were collected. Multiple linear regression analysis was applied to identify the potential predictors related to main outcome. Results: The regression model revealed that the initial Fugl-Meyer upper limb score was the most important predictor for ARAT change score post-test, followed by time since stroke onset and location of stroke lesion. At 2-month follow-up, the neuromuscular electrical stimulation dosage became a significant determinant in addition to the above predictors. Conclusion: Initial motor severity and lesion location were the main predictors for upper limb functional improvement in stroke patients. Neuromuscular electrical stimulation dosage became a significant determinant for upper limb functional recovery after stroke at 2-month follow-up. More intensive neuromuscular electrical stimulation therapy during early rehabilitation is associated with better upper limb motor function recovery after stroke.
Neuropsychiatric Disease and Treatment, 2021
Background: The obstacle of limb motor caused by stroke, especially the decline of motor function of upper limbs, can directly affect the activities of daily living of stroke patients with hemiplegia. Based on long-term clinical practice, the treatment effect of electrical stimulation methods for stroke limb dysfunction has been widely recognized and supported by authoritative guidelines and systematic reviews. However, which electrical stimulation method is the optimum in the treatment of stroke limb dysfunction is still a controversial issue. Objective: In this paper, we adopted Network Meta-Analysis (NMA) to rank the priorities of various electrical stimulation methods, so as to select the optimal electrical stimulation method and discuss its rationality in guiding clinical practice. Methods: We carried out a systematic review by searching a total of 6806 studies from 8 databases and 2 clinical trial registries, and finally screened out 34 studies for further investigation. Then, pairwise meta-analysis and Bayesian network meta-analysis were employed to evaluate the effectiveness and ranking of various interventions. The primary outcome measure was Fugl-Meyer Assessment Upper Extremity (FMA-UE), and the secondary outcome measures were Modified Barthel Index (MBI) and Modified Ashworth Scale (MAS). Finally, the risk of bias, publication bias and sensitivity of the Randomized Controlled Trials (RCTs) were evaluated. Results: On the basis of comprehensive rehabilitation treatment (RT), the Functional Electrical Stimulation (FES) was superior than other electrical stimulation methods in improving both FMA-UE and MBI. Meanwhile, the results indicated that the Transcutaneous Electrical Acupoint Stimulation (TEAS) was the only electrical stimulation method that showed treatment advantages in reducing MAS. Conclusion: The study showed that FES had the optimal overall rehabilitation effect on upper limb dysfunction of stroke patients based on the comprehensive RT, while the treatment effect of TEAS on upper limb spasticity after stroke was the most significant.
Journal of Korean Medicine
There have been several studies evaluated effect of electroacupuncture (EA) on spasticity but most studies could not assess spasticity quantitatively because they used clinical rating scales for assessment spasticity. The objective of this study is to evaluate effect of EA on poststroke spasticity quantitatively using tendon reflex (T-reflex). Methods: 29 stroke patients with upper extremity spasticity were randomized to EA group and control group. The EA group received combined EA and rehabilitation therapy 5 times a week for 3 weeks. Acupuncture treatment was given at Jian Yu (LI 15), Qu Chi (LI 11), Shao Hai (HT 3), Wai Guan (TE 5), He Gu (LI 4), Lie Que (LU 7), Hou Xi (SI 3) of the affected side, 30 minutes of electrical stimulation with a frequency of 40/13 Hz was applied at Qu Chi (LI 11), He Gu (LI 4). The control group received only rehabilitation therapy. The efficacy of treatment was assessed using T-reflex latency and amplitude, modified Ashworth scale (MAS) of biceps brachii, brachioradialis and triceps brachii. Fugl-Meyer motor function assessment (FMA) and functional independence measure (FIM) were also measured to assess motor function and functional independence. All outcomes were measured before treatment, immediately after 3 weeks of treatment and 1 week after 3 weeks of treatment. Results: No statistically significant differences were found in outcomes including T-reflex between the study groups except for FIM values immediately after 3 weeks of treatment (p=0.037). Conclusions: These results suggest that 3 weeks of EA does not reduce poststroke upper extremity spasticity electrophysiologically and clinically. However, small sample sizes and contradictory tendency between results from T-reflex and those from MAS require cautious judgement on interpretation of the results. A larger, well-designed clinical trials for quantitative evaluation of effect of EA on poststroke spasticity will be needed.
Selection of acupoints for managing upper-extremity spasticity in chronic stroke patients
Clinical Interventions in Aging, 2014
Background: This study investigated the clinical efficacy of electroacupuncture (EA) in inhibiting upper-extremity spasticity in chronic stroke patients, and also in mapping a unique preliminary acupoint-selection protocol. Methods: Fifteen patients were divided into two groups: patients in the control group (n=6) received minimal acupuncture (MA), and those in the experimental group (n=9) received EA. Four acupoints, which include Neiguan (PC6), Shaohai (HT3), Zeqian (Ex-UE, A32), and Shounizhu (EX-UE), were treated near the motor points of the muscles for elbow flexion, forearm pronation, and finger flexion. Both groups were treated for twelve sessions, 20 minutes per session, for 6 weeks (two sessions per week). The outcome measures in this study included angle of muscle reaction (R1), passive range of motion (R2), and dynamic component (R2-R1). Results: In the experimental group, the R2-R1 of the elbow joint was significantly decreased at 1 (P=0.0079), 3 (P=0.0013), and 6 weeks (P=0.0149) after treatment compared with pretreatment levels (P,0.05). The between-group difference in the R2-R1 of the elbow joint after the 6-week treatment was statistically significant. Conclusion: Combining the 6-week EA and standard rehabilitation treatment reduced the spasticity of the elbow for chronic stroke survivors. However, no significant effect was observed in the spasticity of the wrist joints. The choice of acupoints and the frequency of EA have to be taken into account to achieve a positive treatment effect. The correlation between acupoints and motor points provides a model of acupoint selection to improve spasticity.
Journal of Exercise Science and Physiotherapy, 2019
Background: Role of Neuro Muscular Electrical Stimulation on hand function in patients with stroke has not being well established. Objective: To estimate the effectiveness of Neuromuscular Electrical Stimulation in improving hand function of patients with sub acute stroke. Data Source: Systemic search was carried out in Medline, Cochrane and Pubmed Databases from August 2018 to June 2019. Study Selection: Randomized controlled trials. Eligibility criteria: subjects >18 yrs suffering from haemorrhagic /ischaemic stroke within 6 months, NMES as intervention applied on affected hand using surface electrodes, outcome measures related to skeletal, muscular and functional characteristics of arm and statistical analysis of results. Data Extraction: Participant's characteristics, NMES parameters, and other relevant data was extracted from the articles and then tabulated. Cochrane collaboration's tool for assessing risk of bias was applied to all articles and methodological quality was assessed by PEDro scale. Data Synthesis: Eighty-one articles were selected through database and citation by title content, 48 articles were screened after reading the abstract. 31 full text articles were found and 15 comply with inclusion criteria. The methodological quality of the articles was assessed through PEDro scale which was between 5/10 and 8/10. Beneficial impact of NMES on muscle tone, motor function, manual dexterity and upper limb ADL's was established in level of evidence synthesis. Limitation: It was difficult to group studies and quantitatively evaluate outcomes due to the variance in protocol s, participant features, outcome measures and NMES parameters.Conclusion:Randomized trials ha ve shown beneficial impacts of electrical stimulation on the wrist and hand despite methodological constraints, implying that NMES is efficient in encouraging the impacted hand in stroke.