Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

The Long-Term Effects of High-Frequency Transcutaneous Electrical Nerve Stimulation(TENS) on the Lower Limb Spasticity and the Balance in the Chronic Stroke Patients

장기간 고빈도 경피신경전기자극이 뇌졸중 환자의 하지 경직 및 균형에 미치는 영향

  • 인태성 (삼육대학교 물리치료학과) ;
  • 조휘영 (삼육대학교 물리치료학과) ;
  • 이순현 (삼육대학교 물리치료학과) ;
  • 이동엽 (선문대학교 물리치료학과) ;
  • 이재국 (선문대학교 응급구조학과) ;
  • 송창호 (삼육대학교 물리치료학과)
  • Received : 2011.02.22
  • Accepted : 2011.04.07
  • Published : 2011.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to investigate effects of the long-term high-frequency transcutaneous electrical nerve stimulation(TENS) on the spasticity and the balance in chronic stroke patients. Twenty-six subjects with spasticity over lower limbs were allocated randomly into two groups under standard rehabilitation: (1) TENS group, (2) placebo-TENS group. TENS stimulation was applied on the both the gastrocnemius for 30 minutes, 5 days a week for 4 weeks(100 Hz, 0.25 ms, 2 times sensory threshold). The Modified Ashworth Scale(MAS) and Hand-held manual muscle tester were used to assess the ankle plantarflexor spasticity. Balance function under three conditions was measured by using force-plate and the amount of postural sway was assessed; in (1) the condition of standing with eyes opened, (2) with eyes closed and (3) the condition of standing on unstable surface with eyes opened. Both groups showed significant improvement in spasticity and balance function after treatment for 4 weeks(p<.05). Especially, TENS group showed a significant reduction of spasticity compared to placebo-TENS group(p<.05). These results suggested that additional stimulation of a long-term high-frequency TENS to standard rehabilitation induced an improved balance function and a spasticity reduction. The long-term application of high-frequency TENS will be an effective intervention for reducing spasticity and increasing balance ability in the chronic stroke patients.

본 연구는 장기간의 고빈도 경피신경전기자극이 뇌졸중 환자의 하지 경직 및 균형 개선에 미치는 효과를 알아보고자 하였다. 하지에 경직이 유발된 26명의 대상자를 기본적인 재활을 수행하는 상태에서 무작위로 TENS군(14명)과 속임 TENS군(12명)으로 배정하였다. 경피신경전기자극은 4주간 주 5회, 1회당 30분씩 경직이 유발된 양측 비복근에 적용하였다. MAS와 도수근력계를 이용하여 발목 족저굴곡근의 경직을 측정하였다. 균형의 측정은 힘판을 이용하여 세 가지 자세(눈을 뜬 상태의 기립자세, 눈을 감은 상태의 기립자세, 불안정한 면에서 눈을 뜬 상태의 기립자세)에서 누적된 자세동요의 이동거리를 측정하였다. 4 주간의 치료 후 양측 군 모두 경직과 균형의 유의한 개선을 나타냈다(p<.05). 특히, TENS군은 속임 TENS군에 비하여 경직의 유의한 감소를 나타냈다(p<.05). 따라서 장기간 고빈도 경피신경전기자극은 뇌졸중 환자의 경직 감소와 균형 개선에 더욱 효과적인 중재 방법으로 사용될 수 있을 것으로 사료된다.

Keywords

References

  1. Belgen, B., Beniato, M., Sullivan, P, E., & Nariewalla, K, "The assosiation of balance capacity and falls self-efficancy with history of falling in community-dwelling people with chronic stroke", Archives of Physical Medicine and Rehabilitation, vol 87(4), pp. 553-561, 2006.
  2. Fatone S, Hansen AH, "Effect of ankle-foot orthosis on roll-over shape in adults with hemiplegia", J Rehabil Res Dev, vol 44(1), pp. 11-20, 2007. https://doi.org/10.1682/JRRD.2006.08.0090
  3. Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM; Women's Health and Aging Study, "Risk factors for falling in home-dwelling older women with stroke: the Women's Health and Aging Study', Stroke, vol, 34(2), pp. 494-501, 2003. https://doi.org/10.1161/01.STR.0000053444.00582.B7
  4. Kollen BJ, Lennon S et al. "The effectiveness of the Bobath Concept in Stro다 Rehabilitation. What is the Evidence?" Stroke, vol 40, pp. e89-e97, 2009. https://doi.org/10.1161/STROKEAHA.108.533828
  5. Welmer, A. K., Holmqvist, L. W., & Sommerfeld, D. K, "Hemiplegic limb synergies in stroke patients" Am J Phys Med Rehabil, vol 85(2), pp. 112-119, 2006. https://doi.org/10.1097/01.phm.0000197587.78140.17
  6. Lance, J. W, "The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture", Neurology, vol 30(12), pp. 1303-1313, 1980. https://doi.org/10.1212/WNL.30.12.1303
  7. McClelland, S., 3rd, Teng, Q., Benson, L. S., & Boulis, N. M, "Motor neuron inhibition-based gene therapy for spasticity", Am J Phys Med Rehabil, vol 86(5), pp. 412-421, 2007. https://doi.org/10.1097/PHM.0b013e31804a83cf
  8. Dickstein, R., Laufer, Y., &Katz, M, "TENS to the posterior aspect of the legs decreases postural sway during stance", Neurosci Lett, vol 393(1), pp. 51-55, 2006. https://doi.org/10.1016/j.neulet.2005.09.039
  9. Satkunam, L. E, "Rehabilitation medicine: 3. Management of adult spasticity", CMAJ, vol 169(11), pp. 1173-1179, 2003.
  10. Shakespeare, D. T., Boggild, M., & Young, C, "Anti-spasticity agents for multiple sclerosis", Cochrane Database Syst Revvo, vol(4), pp. CD001332, 2001.
  11. Ng, S. S., & Hui-Chan, C. W, "Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke", Stroke, vol 38(11), pp. 2953-2959, 2007. https://doi.org/10.1161/STROKEAHA.107.490318
  12. Alabdulwahab, S. S., & Al-Gabbani, M, "Transcutaneous electrical nerve stimulation of hip adductors improves gait parameters of children with spastic diplegic cerebral palsy", NeuroRehabilitation, vol 26(2), pp.
  13. Ng SS, Hui-Chan CW, "Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial", Clin Rehabil, vol 23(12):pp. 1093-103, 2009.115-122, 2010.
  14. Chung BPH. Cheng BKK, "Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury", Clinical Rehabilitation. vol 24(3), pp. 202-210, 2010. https://doi.org/10.1177/0269215509343235
  15. Miller, L., Mattison, P., Paul, L., & Wood, L, "The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis", Mult Scler, vol 13(4), pp. 527-533, 2007.
  16. 조휘영, 인태성, 이순현, 이규창, 신원섭, 이용우, 송창호, "고빈도 경피신경전기자극이 편마비 환자의 하지 경직과 균형에 미치는 즉각적인 효과", 대한물리의학회, 제(5권), 제(3호), pp. 487- 498, 2010.
  17. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A, "Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study", Arch Phys Med Rehabil, vol, 86(3), pp. 410-5, 2005. https://doi.org/10.1016/j.apmr.2004.10.022
  18. Katz RT, Rymer WZ, "Spastic hypertonia: mechanism and measurement", Arch Phys Med Rehabil, vol 70, pp. 144-55, 1989.
  19. Knikou M, Schmit BD, Chaudhuri D, Kay E, Rymer WZ, "Soleus H-reflex excitability changes in response to sinusoidal hip stretches in the injured human spinal cord", Neurosci Lett, vol 9;423(1), pp. 18-23, 2007. https://doi.org/10.1016/j.neulet.2007.06.032
  20. Armutlu, K., Meric, A., Kirdi, N., Yakut, E., & Karabudak, R, "The effect of transcutaneous electrical nerve stimulation on spasticity in multiple sclerosis patients: a pilot study", Neurorehabil Neural Repair, vol 17(2), pp. 79-82, 2003. https://doi.org/10.1177/0888439003017002001
  21. Bakhtiary AH, Fatemy E, "Does electrical stimulation reduce spasticity after stroke? A randomized controlled study", Clin Rehabil, vol 22(5), pp. 418-25, 2008 May. https://doi.org/10.1177/0269215507084008
  22. Yan T, Hui-Chan CW, "Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial", J Rehabil Med, vol, 41(5), pp. 312-6, 2009. https://doi.org/10.2340/16501977-0325
  23. Sluka KA. "MEchanisms and Management of Pain for the Physical Therapist. Chapter 8: Transcutaneous Electrical Nerve Stimulation and Interferential Therapy. Seattle, IASP Press. International Association for the Study of Pain. 2009.
  24. Carroll D,Tramer M, McQuay H, et al, "Randomization is important in studies with pain outcomes: Systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain, British Journal of Anaesthesia, vol 77(6), pp. 798-803, 1996. https://doi.org/10.1093/bja/77.6.798
  25. Lamontagne, A., Malouin, F., Richards, C. L., & Dumas, F, "Evaluation of reflex- and nonreflex-induced muscle resistance to stretch in adults with spinal cord injury using hand-held and isokinetic dynamometry", Phys Ther,vol 78(9), pp. 964-975; discussion 976-968, 1998.
  26. Lewis KS, Mueller WM.Ann Pharmacother, "Intrathecal baclofen for severe spasticity secondary to spinal cord injury,1993 Jun;vol 27(6), pp. 767-74, 1993.
  27. Kita M, Goodkin DE. "Drugs used to treat spasticity", Drugs, vol 59(3), pp. 487-95, 2000. https://doi.org/10.2165/00003495-200059030-00006
  28. Maeda Y, Lisi TL, Vance CG, Sluka KA, "Release of GABA and activation of GABA(A) in the spinal cord mediates the effects of TENS in rats", Brain Res, vol, 1136(1), pp. 43-50, 2007. https://doi.org/10.1016/j.brainres.2006.11.061
  29. Dong HW, Wang LH, Zhang M, Han JS, "Decreased dynorphin A (1-17) in the spinal cord of spastic rats after the compressive injury", Brain Res Bull, vol, 67(3), pp. 189-95, 2005. https://doi.org/10.1016/j.brainresbull.2005.06.026
  30. Perennou DA, Leblond C, Amblard B, Micallef JP, Herisson C, Pelissier JY, "Transcutaneous electric nerve stimulation reduces neglect-related postural instability after stroke", Arch Phys Med Rehabil, vol 82(4)pp. 440-8, 2001. https://doi.org/10.1053/apmr.2001.21986
  31. Lord SR, Clark RD. Webster IW. "Physiological Factors Associated with Falls in an Elderly Population.", Journal of the American Geriatrics Society, vol 39(12), pp. 1194-1200, 1991.
  32. Hatzitaki V, Pavlou M, Bronstein AM. "The integration of multiple proprioceptive information: effect of ankle tendon vibration on postural responses to platform tilt.", Exp Brain Res, vol 154(3), pp. 345-54, 2004. https://doi.org/10.1007/s00221-003-1661-8
  33. Farkas T, Kis Z, Toldi J, et al. "Activation of the primary motor cortex by somatosensory stimulation in adult rats is mediated mainly by associational connections from the somatosensory cortex.", Neuroscience, vol 90(2), pp. 353-361, 1999. https://doi.org/10.1016/S0306-4522(98)00451-5

Cited by

  1. Antispastic Effect of Electroacupuncture on Upper Extremity in Stroke Patients by T-reflex Study: A Single-Blind, Randomized Controlled, Preliminary Study vol.36, pp.4, 2015, https://doi.org/10.13048/jkm.15029