Park J, Seo D, Choi W, Lee S. The effects of exercise with TENS on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Med Sci Monit. 2014;20:1890-6. Level or evidence: Randomized Controlled Trial – Level 2 Target Population: This study targeted patients with chronic stroke with impairments included balance, gait, and spasticity. Patients in this study were included if they had been diagnosed with a hemiplegic stroke greater than 6 months prior to study, and were able to walk at least 10 m independently. Patients were excluded if they showed impaired cognition of greater than 24 on Mini Mental State Exam, other orthopedic impairments, and visual or auditory disorders. 34 patients were eligible for participation in this study. Type of electrotherapy used in article: This study used two groups to determine effect of TENS and exercise. One group used subclinical TENS in conjunction with exercise; the other group used placebo TENS with exercise. Specific electrotherapy parameters used in this article: Two channel TENS was used with 5 cm2 electrodes placed on involved medial and lateral quads and gastrocnemius. The TENS was set to 100 Hz frequency with pulse width of 200 microseconds. Amplitude was set at sub-sensory threshold of .01 mA, which was 90% less amplitude than threshold. Patients received the treatment for 30 minutes. Protocol used in this article: Two groups were used in this study, one group with subclinical TENS and exercise, the other group with placebo TENS and exercise. The patients were seen for 30 minute sessions overseen by a physical therapist. The sessions included 10 minutes of one-to-one ROM exercise, 10 minutes of functional mat exercises, and 10 minutes of gait exercises. Specific exercises were not mentioned in this article. Outcome found with the protocol: Patient outcomes were measured with Modified Ashworth Scale (MAS) for spasticity, Good Balance device for postural sway (anterior/posterior sway, medial/lateral sway, speed, and speed moment), Timed Up and Go (TUG) for dynamic balance, and OptoGait gait analyzer to measure temporal and spatial gait parameters. TENS group showed more improvement in MAS scores than placebo. TENS group showed significant improvement before and after treatment in TUG scores; TENS group was also more improved than placebo group. TENS group showed significant improvement in the balance parameters of eyes closed and open, anterior posterior and medial lateral postural sway velocity, and velocity movement between before and after treatment; there was significant difference between mean pre and post-tests of TENS and placebo. TENS groups showed significant improvement before and after treatment in gait parameters of velocity, cadence, paretic step length, and paretic stride length; placebo group only showed significant improvements in velocity before and after treatment. More improvements were seen between groups in cadence, paretic step length, and paretic stride length. Author’s conclusion: The results from this study showed improvements and significant differences in all parameters between pre and post treatment tests in TENS group and between TENS and placebo group. The improvements in gait are able to increase symmetry in gait with paretic leg and the improvements in gait are able to influence the patients overall balance. Improvements in MAS scores with TENS patients will allow the patients to move more functionally with less interference to locomotive economy. The improvements in TUG scores show improvements in functional parameters. Overall, I believe that this TENS strategy will be effective with functional improvements in patients recovering from a chronic stroke. With the sub-sensory amplitude, patients with decreased tolerance or altered sensation will be able to use the TENS with no adverse effects. Additionally, I believe that since there were significant differences seen in therapy treatment after a chronic stroke, there is no adverse effect to using this treatment and the patient would only benefit from the attempt.

• published: 21 Mar 2015
• views: 2