Kim, Ji-hyun;Kwon, Oh-yun;Jeon, Hye-seon;Hwang, Ui-jae;Gwak, Kyeong-tae;Yoon, Hyeo-bin;Park, Eun-young
한국전문물리치료학회지
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제26권3호
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pp.67-75
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2019
Background: Stress urinary incontinence (SUI) is an involuntary leakage of urine from the urethra when intra-abdominal pressure increases, such as from sneezing, coughing, or physical exertion. It is caused by insufficient strength of the pelvic floor and sphincter muscles, resulting from vaginal delivery, obesity, hard physical work, or aging. The pelvic floor electrical stimulator is a conservative treatment generally used to relieve the symptoms of urinary incontinence. it recommended to applied before surgery is performed. Objects: The purpose of this study was to determine if the transcutaneous electrical stimulation (TCES) would be effective for the physiological symptoms and psychological satisfaction of women with SUI for an 8-weeks intervention. Methods: Easy-K is a specially designed user-friendly TCES. Five female who were diagnosed with SUI by a gynecologist but who did not require surgical intervention were included in this study. Intervention was implemented over an 8-week period. Outcome measures included vaginal ultrasonography, Levator ani muscle (LAM) contraction strength, incontinence quality of life (I-QOL), and female sexual function index (FSFI) questionnaires. Results: The bladder neck position significantly decreased across assessment time. Funneling index and urethral width significantly decreased after 8 weeks of intervention (p<.05). The bladder necksymphyseal distance and posterior rhabdosphincter thickness statistically increased and the anterior rhabdosphincter thickness showed a tendency to increase. All participants demonstrated a significant increase in the LAM contraction score across three assessment times (p<.05). Although the total score of the I-QOL did not show significant improvement, it steadily increased and among I-QOL subscales, only the "avoidance" subscale showed statistical improvements (p<.05). The total score of the FSFI statistically improved and the "desire" score significantly changed (p<.05). Conclusion: The TCES is recommended for women who want to apply conservative treatments before surgery and who have suffered from SUI in aspects of sexual function and quality of life.
We investigated the activation of the cerebral cortex during active movement, passive movement, and functional electrical stimulation (FES), which was provided on wrist extensor muscles. A functional magnetic resonance imaging study was performed on 5 healthy volunteers. Tasks were the extension of right wrist by active movement, passive movement, and FES at the rate of .5 Hz. The regions of interest were measured in primary motor cortex (M1), primary somatosensory cortex (SI), secondary somatosensory cortex (SII), and supplementary motor area (SMA). We found that the contralateral SI and SII were significantly activated by all of three tasks. The additional activation was shown in the areas of ipsilateral S1 (n=2), and contralateral (n=1) or ipsilateral (n=2) SII, and bilateral SMA (n=3) by FES. Ipsilateral M1 (n=1), and contralateral (n=1) or ipsilateral SII (n=1), and contralateral SMA (n=1) were activated by active movement. Also, Contralateral SMA (n=3) was activated by passive movement. The number of activated pixels on SM1 by FES ($12{\pm}4$ pixels) was smaller than that by active movement ($18{\pm}4$ pixels) and nearly the same as that by passive movement ($13{\pm}4$ pixels). Findings reveal that active movement, passive movement, and FES had a direct effect on cerebral cortex. It suggests that above modalities may have the potential to facilitate brain plasticity, if applied with the refined-specific therapeutic intervention for brain-injured patients.
The purpose of this study was to test the microcurrent electrical neuromuscular stimulation on muscle soreness, serum creatine kinase levels and force deficits evident following a high-intensity eccentric exercise bout. 10 volunteer male subjects were randomly assigned to a treatment group or to a control group. Exercise consisted of high-intensity eccentric contractions of the elbow flexors. Resistance was reduced as subjects fatigued, until they reached exhaustion. Muscle soreness rating was determined using a visual analog scale. Serum creatine kinase levels were analyzed using a blood sample. Force deficits were determined by measures of maximal voluntary isometric contraction at $90^{\circ}$ of elbow flexion on a Orthotron II dynamometer. Muscle soreness rating, serum creatine kinase levels and maximal voluntary isometric contraction were determined at the before exercise and again at 24 and 48 hours postexericse. Treatments were applied immediately following exercise. The control group subjects rested following their exercise bout. Statistical analysis showed significant increases in muscle soreness rating and significant decreases in maximal voluntary isometric contraction when the before exercise was compared with 24 and 48 hour measures(p<0.01). No significant effects were observed between groups in muscle soreness rating and maximal voluntary isometric contraction(p>0.05). Highly significants differences in serum creatine kinase levels were found using on Analysis of variance(ANOVA) repeated measures between groups for each time cycles(p<0.001). This modality may have benefits when used early stage in the muscle damage.
We randomly assigned 61 healthy subjects(male 14, female 47) to compare the experimental pain threshold and skin temperature between high mode TENS and burst mode TENS. In this study, 61 subjects were divided into three groups ; high mode TENS(n=20), burst mode TENS (n=20), and control group(n=21). Experimental pain thresholds and skin temperatures were measured before, immediately after cessation of stimulation, and at 30 minutes post stimulation. Stimulation was applied to the dorsal surface of the forearm(L14, LI10). Pain thresholds were measured by chronaxie meter. Skin temperature were measured by electrical digital thermometer. The results are as follows ; 1. There were no statistical difference in the pain threshold and skin temperature at before TENS stimulation among the three groups(p>0.05). 2. The pain threshold and skin temperature in burst mode TENS group was significantly higher and longer effect than that in high mode TENS group and control group(p<0.01). 3. The pain threshold in burst mode TENS group decreased to prestimulation levels by 30 minutes poststimulation. 4. The skin temperature in burst mode TENS group decreased to prestimulation levels by 20 minutes poststimulation. 5. The skin temperature was significantly difference among three group at immediately after, and at 30 minutes poststimulation and the skin temperature in burst mode TENS group was significantely higher than that in two groups(p<0.001). 6. The increasing rate of pain threshold in high mode TENS group after immediately cassation of stimulation was 24.3%(p<0.001). 7. The increasing rate of pain threshold in burst mode TENS group after immediately cessation of stimulation was 93.5% (p<0.001).
Purpose: Flexibility has been considered one of the most important goals in rehabilitation. This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) with the static stretching technique on the flexibility of hamstrings. Methods: Twenty-four subjects (15 men, 9 women) with limited hamstrings flexibility received three different intervention sessions in random order. The treatment sessions included static stretching (SS), static stretching with motor-level TENS (SS with motor TENS) and sensory-level TENS (SS with sensory TENS). All sessions of SS were performed in the straight-leg raise position for 30 seconds followed by rest for 15 seconds, in repetitions for 10 minutes using a belt. The TENS groups underwent TENS stimulation ($40{\mu}s$, 100 Hz) during the stretching for 10 minutes. Outcome measures were evaluated according to active knee extension (AKE) and recorded before the session and at 0, 3, 6, 9, and 15 minutes after the session. Results: There was significant improvement in hamstrings flexibility within all groups (p<0.05). SS with TENS (both sensory and motor) maintained significant increases in knee extension range of motion until 15 minutes post-treatment. In contrast, the SS-only group maintained significantly increased hamstrings flexibility only until 6 minutes post-treatment (p<0.05). Conclusion: Improvement in hamstrings flexibility with SS with TENS was maintained longer than with SS-only intervention. Electrical stimulation with stretching may be more effective than SS alone for increased duration of maintained hamstrings flexibility.
Purpose : This study examines the effects of pre-eccentric exercise and stretch ing to bicepsbrachii to prevent delayed onset muscle soreness and recovery of muscular function depending on the training intensity with 28 normal adults in their twenties. Methods : The subjects were divided into a control group, a group without any previous eccentric exercise, and a stretching group. Pre-eccentric exercise group conducted exercise with the intensity of 25% of maximal voluntary contraction. Pre-eccentric exercise and stretching was applied before to induce delayed onset muscle soreness and after, 24 hour post, 48 hour post, and 72 hour post. Measurements were conducted to examine pain and muscular function changes before, immediately after, and after inducing delayed onset muscle soreness. After inducing delayed onset muscle soreness, measurements were taken at the 24th hour, 48th hour, and 72nd hour. Results : The pre-eccentric exercise group and stretching group showed a significant difference from the control group by isometric contract ion power and mechanical pain threshold as a result of measuring delayed onset muscle soreness. Conclusion : From these results, electrical stimulation using presynaptic inhibition mechanism of transcutaneous electrical stimulation (TES) had positive effects for walking ability on inhibition of muscle tone in lower extremity. The motor level stimulation group experienced a more significant effect than the sensory level stimulation group. Therefore, the transcutaneous electrical stimulation (TES) is considered to be effective on walking ability increasing through inhibition of muscle tone in lower extremity for rehabilitation of post stroke hemiplegic patients.
Purpose: This study aims to examine the power changes in eletrocenphalogram (EEG) detected from the tibialis anterior muscle, during repetitive contraction exercise in normal female adults. Methods: The subjects of this study were 24 normal adult females, with no musculoskeletal or nervous system disorders. The 24 female subjects were divided into two groups: 12 subjects comprised a voluntary stimulation training group, and the other 12 subjects comprised an electrical stimulation training group. A total of thirty contractions were made repetitively by each woman, with maximal voluntary contraction exercise for six seconds, and a resting time of three seconds. During the experiment, their EEG was measured at eight positions. The eight positions were Fpz, Fz, Cz, CPz, C3, C4, P3, and P4, in accordance with the international 10~20 system. Results: The relative alpha power and beta power showed no statistically significant differences between the two groups. But the relative gamma power of the CPz, C3, C4, P3, and P4 areas showed statistically significant differences between the two groups (p<0.05). The relative theta power of the C4 area showed statistically significant differences between the two groups (p<0.05). Conclusion: Our findings show that tibialis anterior muscle contraction by electrical stimulation and by voluntary repeated contraction differentially affected brain activation. In particular, the CPz, C3, C4, P3 positions of relative gamma power showed brain activation in voluntary contraction. The C4 position of relative theta power showed different brain activation between the two groups.
Background: Trigeminal neuralgia (TN) is a severe form of pain that affects the daily activities of a patient. Transcutaneous electrical nerve stimulation (TENS) therapy is an emerging option for the treatment of acute and chronic pain. The aim of this study was to evaluate the effect of TENS therapy as an adjunct to drug therapy for the treatment of TN. Methods: A total of 52 patients diagnosed with TN according to the International Classification of Headache Disorders (version 3) were included. Each patient was randomized to either the TENS or placebo TENS groups. Intervention was given in continuous mode and 100-Hz frequency for 20 mins biweekly for 6 weeks. Parameters were measured at baseline, TENS completion and 3 months, 6 months, and 1 year of follow up. The parameters observed were mean carbamazepine dose, mean visual analog scale (VAS) score, mean present pain intensity (PPI) score, and functional outcome. Non-parametric analyses, one-way ANOVA and the Kruskal-Wallis test were applied for intragroup comparisons, while the Mann-Whitney U test and independent t-test were used for intergroup comparisons of variables. The chi-square test was applied to analyze categorical data. Results: Compared to the placebo TENS group, the mean dose of carbamazepine in the TENS group was significantly reduced at TENS completion, as well as at 6 months and 1 year follow up. Changes in mean VAS score, mean PPI score, and functional outcome did not show significant differences between the groups (P>0.05). Conclusion: TENS therapy does not lead to any changes in pain levels but it may reduce the mean dose of carbamazepine when used as an adjunct treatment in patients with TN.
Purpose: The purpose of this study was to examine the effect of weight-bearing training with an elastic band during functional electrical stimulation (FES) on walking and balance functions in stroke patients. Methods: Twenty patients with chronic stroke were divided into an experimental group assigned to weight-bearing training with an elastic band during functional electrical stimulation (FES; n=10) and a control group assigned to weight-bearing training alone during FES (n=10). The patients in both groups attended physical therapy sessions five times a week for four consecutive weeks. The experimental group underwent weight-bearing training with an elastic band during FES five times a week for four weeks. The control group underwent weight-bearing training during FES. Balance parameters were measured before and after the intervention using the Balancia program. Moreover, all patients were evaluated using the Berg Balance Scale (BBS), the Time Up and Go Test (TUGT), and the Wisconsin Gait Scale (WGS) before and after each intervention. Results: The results showed that weight-bearing training with elastic bands during FES and weight-bearing training during FES had a significant effect on the affected side's weight-bearing ratio, BBS, TUGT, and WGS in both groups (p <0.05). Additionally, the results showed that the changes observed in the two groups indicate significant differences in path length, average speed, BBS score, TUGT time, and WGS score between the groups (p < 0.05). Conclusion: In patients with stroke, weight-bearing training with an elastic band during FES affected on walking and balance. Therefore, it is an optional intervention for the balance and walking ability of stroke patients.
Purpose : This study aimed to investigate how neuromuscular electrical stimulation (NMES) affects the balance ability of patients who have undergone total knee arthroplasty owing to osteoarthritis. Methods : Thirty patients who had undergone total knee arthroplasty were randomized to an experimental group (n=15) and a control group (n=15). The experimental group received conventional physical therapy for 50 minutes and NMES treatment for 30 minutes, whereas the control group received conventional physical therapy for 50 minutes and active range of motion (AROM) exercises for 30 minutes. Within-group and between-group changes in static and dynamic balance ability before and after the 4-week intervention were analyzed. Results : In the within-group comparison, sway velocity in the center of gravity and total distance were significantly improved in both the experimental and control groups (p<.05), with no significant differences between the groups (p>.05). In the within-group comparison, both the experimental and control groups showed significant improvement in the functional reach test and movement velosity (p<.05). In the between-group comparison, the experimental group showed a significantly better improvement than the control group in the functional reach test (p<.05), but there was no significant difference in the movement velosity test (p>.05). Conclusion : In this study, NMES improved the static and dynamic balance in patients who had undergone total knee arthroplasty. Compared with AROM exercises, there was a greater effect on dynamic balance partially; however, the overall effect was similar. Therefore, NMES may be one option among various interventions to improve the balance ability in patients who have undergone total knee arthroplasty. In particular, this method may be effective when it is difficult to apply balance training for patients with total knee arthroplasty in a clinical setting.
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