Author: Chung, Ping-ho
Title: Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury
Degree: M.Sc.
Year: 2004
Subject: Hong Kong Polytechnic University -- Dissertations
Neural stimulation -- Therapeutic use
Transcutaneous electrical nerve stimulation
Spinal cord -- Wounds and injuries -- Treatment
Department: Department of Rehabilitation Sciences
Pages: xi, 70 leaves : col. ill. ; 30 cm
Language: English
Abstract: Spasticity is one of the major complaints in patients with upper motor neuron lesion such as spinal cord injury (SCI). Several spinal inhibitory circuits mediated motor neuron inhibitory mechanisms have been found to be decreased in patients with spasticity such as presynaptic inhibition (Burke et al., 1992; Faist et al., 1994; Fellows et al., 1993; Milanov, 1994; Nielsen et al., 1995), reciprocal Ia inhibition (Crone et al., 1994), recurrent inhibition (Mazzocchio and Olivier, 1988) and non-reciprocal lb inhibition (Delwaide and Oliver, 1988). It was suggested that sensory stimulation to peripheral nerves might have positive effect to enhance spinal inhibitory circuits (Crone et al., 1994; Perez et al., 2003). Transcutaneous electrical nerve stimulation (TENS) could be a mean to provide sensory stimulation so as to enhance spinal inhibitory circuits. The purpose of the present study was to investigate the immediate effect of TENS on spasticity in patients with SCI. This was a randomized, double blind and placebo-controlled study for eighteen subjects with SCI with symptoms of spasticity over lower limbs. Subjects either received 60 minutes application of active TENS (0.25ms , 100Hz, 15mA) or received 60 minutes application of placebo non-electrically stimulated TENS over common peroneal nerve (CPN). The initial and final clinical spasticity level of ankle plantar flexors were assessed, immediately before and after TENS application, by a clinical measurement of Composite Spasticity Score (CSS). CSS consisted of Achilles tendon jerks (ATJ), resistance to full-range passive ankle dorsiflexion (RFPAD), and ankle clonus (AC). Between-group statistical differences of reduction of CSS, ATJ, RFPAD and AC were calculated using the non-parametric Mann-Whitney Test. Within-group statistical differences of CSS, ATJ, RFPAD and AC were calculated using the non-parametric Wilcoxon signed ranks test. Statistical differences between parametric data were calculated by independent sample t-test. The results showed significant reductions in CSS by 29.5% (p=0.017), RFPAD by 31.0% (p=0.024) and AC by 29.6% (p=0.023) in TENS group but these reductions were not found in placebo TENS group. The between group differences of both CSS and RFPAD were significant (p=0.027 and p=0.024 respectively). This study provided evidence that a single session of TENS could immediately reduce spasticity. Although the effect was temporary, owing to the effectiveness, simple application, minimal side effect and low manpower requirement, TENS could be a suitable modality to temporary relieves spasticity in patients with SCI.
Rights: All rights reserved
Access: restricted access

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