Transcutaneous Electrical Nerve Stimulation in Conjunction with Task-oriented Training in the Management of Chronic Post-stroke Spasticity of the Upper Limb: A Case Report
Background: Post-stroke spasticity is a major contributor to functional impairment and disability among stroke survivors as it negatively affects recovery and interferes with quality of life.
Case presentation: We present a 45-year-old man with a 6-year history of stroke affecting the right side of the body. He presented with chronic upper limb spasticity and walk with hemiplegic gait without support. The patient received Transcutaneous Electrical Nerve Stimulation (TENS) to the belly of elbow flexors of the right upper limb using a frequency of 100HZ and pulse duration of 200μs for 60 minutes. Six sets of 100 repetitions of task-oriented training were also performed for 60 minutes. All treatments were administered twice weekly for 12 weeks. The patient’s spasticity and motor function were assessed using Modified Ashworth Scale (MAS) and Brunnstrom Recovery Stages (BRS), respectively, before treatment, and 6 weeks and 12 weeks post treatment. There was reduction in spasticity post treatment with more reduction being recorded at 12 weeks. The patient’s motor function also improved post treatment but no difference was observed between the 6 weeks and 12 weeks of treatment.Conclusions: The findings of this study demonstrated the beneficial effect of TENS in conjunction with task-oriented training in reducing chronic post-stroke spasticity and motor function of the upper limb.
Adeloye D, Ezejimofor M, Auta A, Mpazanje RG, Ezeigwe N, Ngige EN, et al. Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis. J Neurol Sci. 2019;402:136-44.
Mendis S. Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke. 2013;8(1):3-4.
Zorowitz RD, Gillard PJ, Brainin M. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology. 2013;80(3 Suppl 2):S45-52.
Doan QV, Brashear A, Gillard PJ, Varon SF, Vandenburgh AM, Turkel CC, et al. Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity. PM R. 2012;4(1):4-10.
Levin MF, Hui-Chan CWY. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;85(2):131-42.
Mahmood A, Veluswamy SK, Hombali A, Mullick A, N M, Solomon JM. Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2019;100(4):751-68.
Marcolino MAZ, Hauck M. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil. 2020;42(5):623-35.
Arya KN, Verma R, Garg RK, Sharma VP, Agarwal M, Aggarwal GG. Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial. Top Stroke Rehabil. 2012;19(3):193-211.
Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225-39.
Bosch J, O’Donnell MJ, Barreca S, Thabane L, Wishart L. Does Task-Oriented Practice Improve Upper Extremity Motor Recovery after Stroke? A Systematic Review. ISRN Stroke. 2014;2014:504910.
Kim TH, In TS, Cho HY. Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke. Tohoku J Exp Med. 2013;231(2):93-100.
Tekeoğlu Y, Adak B, Göksoy T. Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel Activities of Daily Living (ADL) index score following stroke. Clin Rehabil. 1998;12(4):277-80.
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. 2005;86(3):410-5.
Li F, Wu Y, Li X. Test-retest reliability and inter-rater reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in hemiplegic patients with stroke. Eur J Phys Rehabil Med. 2014;50(1):9-15.
Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46(4):357-75.
Jush S, Wang C, Hsieh C, Chen M, Chen C. The Brunnstrom recovery scale: its reliability and concurrent validity. J Occup Ther Assoc ROC. 1996;14:1-12.
Safaz I, Yilmaz B, Yaşar E, Alaca R. Brunnstrom recovery stage and motricity index for the evaluation of upper extremity in stroke: analysis for correlation and responsiveness. Int J Rehabil Res. 2009;32(3):228-31.
Sheean G, McGuire JR. Spastic hypertonia and movement disorders: pathophysiology, clinical presentation, and quantification. PM R. 2009;1(9):827-33.
Francisco Gerard E, McGuire John R. Poststroke Spasticity Management. Stroke. 2012;43(11):3132-6.
Sonde L, Fernaeus S, Nilsson C, Viitanen M. Stimulation With Low Frequency (1.7 Hz) Transcutaneous Electric Nerve Stimulation (Low-Tens) Increases Motor. Scand J Rehab Med. 1998;30:95-9.
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