[KSCI] Korea Science Citation Index Service

http://dx.doi.org/10.13066/kspm.2020.15.2.39

Effects of Integrating Transcutaneous Electrical Nerve Stimulation into Treadmill Gait Training Applying Functional Electrical Stimulation on Spasticity, Balance and Gait Ability in Stroke Patients: A Randomized Controlled Trial

Lee, Mun-Su (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University)
Lee, Myung-Mo (Department of Physical Therapy, Daejeon University)

Publication Information

Journal of the Korean Society of Physical Medicine / v.15, no.2, 2020 , pp. 39-48 More about this Journal

Abstract

PURPOSE: This study examined the effects of integrating transcutaneous electrical nerve stimulation into treadmill gait training by applying functional electrical stimulation on the spasticity, balance, and gait ability of chronic stroke patients METHODS: Twenty participants were assigned randomly to two groups: the treadmill gait training group with applied functional electrical stimulation (FES) with integrated transcutaneous electricalstimulation (TENS) (experimental group, EG, n = 10) and the treadmill gait training group with FES (control group, CG, n = 10). Both groups received treadmill gait training with FES for 30 minutes a time, four times a week, during five weeks. The experimental group received additional TENS on their L3, L5, and S2 dermatome for 30 minutes before the interventions. The spasticity, balance, and gait ability were evaluated before and after the training to compare the intergroup and intragroup changes. RESULTS: Both groups showed significant improvements in the static, dynamic balance, and gait ability (p < .05), but did not show any significant changes in the muscle tone. The EG showed significant improvements in the static balance ability and gait cycle compared to the CG (p < .05). CONCLUSION: Treadmill gait training combined with FES with integrated TENS is an effective method for improving the static balance and gait cycle. On the other hand, the effects of treadmill gait training with FES on spasticity need to be studied further.

Keywords

Functional electrical stimulation; Gait Analysis; Postural balance; Stroke; TENS;

Citations & Related Records

Reference

1	Lamola G, Fanciullacci C, Rossi B, et al. Clinical evidences of brain plasticity in stroke patients. Arch. Ital. Biol. 2014;152:259-71.
2	Fink M, Rollnik JD, Bijak M, et al. Needle acupuncture in chronic poststroke leg spasticity. Archives of physical medicine and rehabilitation. 2004;85(4):667-72. DOI
3	Oujamaa L, Relave I, Froger J, et al. Rehabilitation of arm function after stroke. Literature review. Annals of physical and rehabilitation medicine. 2009;52(3):269-93. DOI
4	Knikou M, Rymer WZ. Effects of changes in hip joint angle on H-reflex excitability in humans. Experimental brain research. 2002;143(2):149-59. DOI
5	Pohl M, Mehrholz J, Ritschel C, et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33(2):553-8. DOI
6	Cho MK, Kim JH, Chung Y, et al. Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis. Gait & posture. 2015;42(1):73-8. DOI
7	Glanz M, Klawansky S, Stason W, et al. Functional electrostimulation in poststroke rehabilitation: a metaanalysis of the randomized controlled trials. Archives of physical medicine and rehabilitation. 1996;77(6):549-53. DOI
8	Yang C-Y, Kim T-J, Joo M-C, et al. The Effect of Functional Electrical Stimulation on the Motor Function of Lower Limb in Hemiplegic Patients Annals of Rehabilitation Medicine. 2009;33(1):29-35.
9	Combs S, Miller EW, Forsyth E. Motor and functional outcomes of a patient post-stroke following combined activity and impairment level training. Physiotherapy theory and practice. 2007;23(4):219-29. DOI
10	van der Linden ML, Hazlewood ME, Hillman SJ, et al. Functional electrical stimulation to the dorsiflexors and quadriceps in children with cerebral palsy. Pediatric Physical Therapy. 2008;20(1):23-9. DOI
11	LEE EW, Shin WS, Jung KS, et al. Reliability and validity of the neck disability index in neck pain patients. Physical Therapy Korea. 2007;14(3):97-106.
12	Ng SS, Hui-Chan CW. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke. 2007;38(11):2953-9. DOI
13	Park S-J, Wang J-S. The immediate effect of FES and TENS on gait parameters in patients after stroke. Journal of physical therapy science. 2017;29(12):2212-4. DOI
14	Robbins SM, Houghton PE, Woodbury MG, et al. The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta-analysis. Archives of physical medicine and rehabilitation. 2006;87(6):853-9. DOI
15	Maeda Y, Lisi T, Vance C, et al. Release of GABA and activation of GABAA in the spinal cord mediates the effects of TENS in rats. Brain research. 2007;1136:43-50. DOI
16	Chen S, Chen Y, Chen C, et al. Effects of surface electrical stimulation on the muscle-tendon junction of spastic gastrocnemius in stroke patients. Disability and rehabilitation. 2005;27(3):105-10. DOI
17	Yan T, Hui-Chan CW. Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial. Journal of rehabilitation medicine. 2009;41(5):312-6. DOI
18	Laddha D, Ganesh GS, Pattnaik M, et al. Effect of transcutaneous electrical nerve stimulation on plantar flexor muscle spasticity and walking speed in stroke patients. Physiotherapy Research International. 2016;21(4):247-56. DOI
19	Park J, Seo D, Choi W, et al. The effects of exercise with TENS on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Medical science monitor: international medical journal of experimental and clinical research. 2014;20:1890. DOI
20	Cho H-y, In TS, Cho KH, et al. A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. The Tohoku journal of experimental medicine. 2013;229(3):187-93. DOI
21	Tong RK, Ng MF, Li LS, et al. Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation. Physical Therapy. 2006;86(9):1282-94. DOI
22	Bakhtiary AH, Fatemy E. Does electrical stimulation reduce spasticity after stroke? A randomized controlled study. Clinical rehabilitation. 2008;22(5):418-25. DOI
23	Kang YW, NA DL, Han SH. A Validity Study on the Korean Mini-Mental State Examination(K-MMSE) in Dementia Patients. Journal of Clinical Neurology. 1997;15:300-8. DOI
24	Potisk KP, Gregoric M, Vodovnik L. Effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with hemiplegia. Scandinavian journal of rehabilitation medicine. 1995;27(3):169-74.
25	Kim YC, Lee SM, Song CH. Effects of Functional Electrical Stimulation on the Balance of Hemiplegic Patients The journal of Korean society of physical therapy. 2004;16(3):539-48.
26	Kesar TM, Reisman DS, Perumal R, et al. Combined effects of fast treadmill walking and functional electrical stimulation on post-stroke gait. Gait & posture. 2011;33(2):309-13. DOI
27	In TS, Cho HY, Lee SH, et al. 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. Journal of the Korea Academia-Industrial cooperation Society. 2011;12(4):1740-8. DOI
28	Thieme H, Ritschel C, Zange C. Reliability and validity of the functional gait assessment (German version) in subacute stroke patients. Archives of Physical Medicine and rehabilitation. 2009;90(9):1565-70. DOI
29	Jeong HY, Choi JD. The effects of vestibular sensory stimulation training on balance and gait in the patients with stroke. The Journal of Korean Physical Therapy. 2014;26(5):365-71.
30	Campbell MJ, Tan S-B, Tan S-H. Sample size tables for clinical studies. John Wiley & Sons. 2009.
31	Charalambous CP. Interrater reliability of a modified Ashworth scale of muscle spasticity. Classic papers in orthopaedics. Springer. 2014. pp.415-7.
32	Yi C-H, Current ME. Inter-Rater Reliability of the Modified Ashworth Scale of Spasticity. Physical Therapy Korea. 1994;1(1):1-9.
33	Gravelle DC, Laughton CA, Dhruv NT, et al. Noiseenhanced balance control in older adults. Neuroreport. 2002;13(15):1853-6. DOI
34	Meseguer-Henarejos A-B, Sanchez-Meca J, Lopez-Pina J-A, et al. Inter-and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. European journal of physical and rehabilitation medicine. 2018;54(4):576-90.
35	Park DS, Lee DY, Choi SJ, et al. Reliability and validity of the balancia using wii balance board for assessment of balance with stroke patients. Journal of the Korea Academia-Industrial cooperation Society. 2013;14(6):2767-72. DOI
36	Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of physical medicine and rehabilitation. 2012;93(7):1201-8. DOI
37	McDonough AL, Batavia M, Chen FC, et al. The validity and reliability of the GAITRite system's measurements: A preliminary evaluation. Archives of physical medicine and rehabilitation. 2001;82(3):419-25. DOI
38	Sadeghi-Demneh E, Tyson SF, Nester CJ, et al. The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) Applied to the Foot and Ankle on Strength, Proprioception and Balance: A Preliminary Study. Clinical Research on Foot & Ankle. 2015.
39	Bogataj U, Gros N, Kljajic M, et al. The rehabilitation of gait in patients with hemiplegia: a comparison between conventional therapy and multichannel functional electrical stimulation therapy. Physical therapy. 1995;75(6):490-502. DOI
40	Moseley A, Wales A, Herbert R, et al. Observation and analysis of hemiplegic gait: stance phase. Australian journal of physiotherapy. 1993;39(4):259-67. DOI