Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury

Abstract

Objective: To investigate the immediate effect of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with spinal cord injury.

Design: Randomized controlled trial.

Setting: Extended rehabilitation centre.

Subjects and intervention: Eighteen subjects with spinal cord injury and symptoms of spasticity over lower limbs were randomly assigned to receive either 60 minutes of active TENS (0.25 ms, 100 Hz, 15 mA) or 60 minutes of placebo non-electrically stimulated TENS over the common peroneal nerve.

Outcome measures: Composite Spasticity Score was used to assess the spasticity level of ankle plantar flexors immediately before and after TENS application. Composite Spasticity Score consisted of Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus. Between-group statistical differences of reduction of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Mann—Whitney test. Within-group statistical differences of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Wilcoxon signed ranks test.

Results: Significant reductions were shown in Composite Spasticity Score by 29.5% (p = 0.017), resistance to full-range passive ankle dorsiflexion by 31.0% (p = 0.024) and ankle clonus by 29.6% (p = 0.023) in the TENS group but these reductions were not found in the placebo TENS group. The between-group differences of both Composite Spasticity Score and resistance to full-range passive ankle dorsiflexion were significant (p = 0.027 and p = 0.024, respectively).

Conclusion: This study showed that a single session of TENS could immediately reduce spasticity.

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References

Levi R. , Hultling C. , Nash MS et al. The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. Paraplegia 1995 ; 33: 308-15.

Sköld C. , Levi R. , Seiger Å. Spasticity after traumatic spinal cord injury: nature, severity, and location. Arch Phys Med Rehabil 1999; 80: 1548-57.

Lundqvist C. , Slösteen A. , Blomstrand C. et al. Spinal cord injuries: clinical, functional, and emotional status. Spine 1991; 16: 78-83.

Joodaki MR , Olyaei GR , Bagheri H. The effects of electrical nerve stimulation of the lower extremity on H-reflex and F-wave parameters. Electromyogr Clin Neurophysiol 2001; 41: 23-28.

Levin MF , Hui-Chan C.

Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?

J Neurol 1993; 240: 63-71.

Levin MF , Hui-Chan CW Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol 1992; 85: 131-42.

Potisk KP , Gregoric M. , Vodovnik L. Effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with hemiplegia. Scand J Rehabil Med 1995; 27: 169-74.

Crone C. , Nielsen J. , Petersen N. et al. Disynaptic reciprocal inhibition of ankle extensors in spastic patients. Brain 1994; 117: 1161-68.

Perez MA , Field-Fote EC , Floeter MK Patterned sensory stimulation induces plasticity in reciprocal Ia inhibition in humans. J Neurosci 2003; 23: 2014-18.

10.

Goulet C. , Arsenault AB , Bourbonnais D. et al. Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity. Scand J Rehabil Med 1996; 28: 169-76.

11.

Bajd T. , Gregoric M. , Vodovnik L. et al. Electrical stimulation in treating spasticity resulting from spinal cord injury. Arch Phys Med Rehabil 1985; 66: 515-17.

12.

Kuhn RA Functional capacity of the isolated human spinal cord. Brain 1950; 73: 1-51.

13.

Maynard Jr FM , Bracken MB , Creasey G. et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord 1997; 35: 266-74.

14.

Ashworth B. Perliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964; 192: 540-42.

15.

Schulz KF , Grimes DA Generation of allocation sequences in randomised trials: chance, not choice . Lancet 2002; 359: 515-19.

16.

Priebe MM , Sherwood AM , Thornby JI et al. Clinical assessment of spasticity in spinal cord injury: a multidimensional problem. Arch Phys Med Rehabil 1996; 77: 713-16.

17.

Nischik M. , Forster C. Analysis of skin erythema using true-color images. IEEE Trans Med Imag 1997; 16: 711-16.

18.

Zarate E. , Mingus M. , White PF et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2001; 92: 629-35.

19.

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. Br J Anaesth 1996; 77: 798-803.

20.

Carroll D. , Tramer M. , McQuay H. et al. Transcutaneous electrical nerve stimulation in labour pain: a systematic review. Br J Obstet Gynaecol 1997; 104: 169-75.

21.

Brashear A. , Zafonte R. , Corcoran M. et al. Inter-and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil 2002; 83: 1349-54.

22.

Adams MM , Hicks AL Spasticity after spinal cord injury. Spinal Cord 2005; 43: 577-86.

23.

Pandyan AD , Johnson GR , Price CIM et al. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil 1999; 13: 373-83.

24.

Meunier S. , Pierrot-Deseilligny E. , Simonetta-Moreau M. Pattern of heteronymous recurrent inhibition in the human lower limb . Exp Brain Res 1994; 102: 149-59.

25.

Burchiel KJ , Hsu FPK. Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine 2001; 26: S146-60.

26.

Ward AB , Kadies M. The management of pain in spasticity. Disabil Rehabil 2002; 24: 443-53.

27.

Jadad AR , Moore RA , Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Contr Clin Trials 1996 ; 17: 1-12.

28.

Olivo SA , Macedo LG , Gadotti IC et al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 2008; 88: 156-75.

29.

Schulz KF , Grimes DA Blinding in randomised trials: hiding who got what. Lancet 2002; 359: 696-700.

30.

Bang H. , Ni L. , Davis CE Assessment of blinding in clinical trials. Contr Clin Trials 2004; 25: 143-56.