| Author: | Chan, Kin Shing Bill |
| Title: | Effects of home-based transcutaneous electrical stimulation (TES) combined with task-related trunk training (TRTT) in improving sitting balance and trunk control in patients with stroke |
| Degree: | DHSc |
| Year: | 2012 |
| Subject: | Cerebrovascular disease -- Patients -- Rehabilitation Cerebrovascular disease -- Treatment Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xxi, 179 leaves : color illustrations ; 30 cm |
| Language: | English |
| Abstract: | Previous studies have shown that repeated sensory inputs from transcutaneous electrical stimulation (TES) could enhance brain plasticity and cortical motor output. Home-based rehabilitation is shown to be effective in motor recovery and improvement of functional ability in stroke rehabilitation. The aim of this thesis was to develop a home-based rehabilitation program to investigate whether combined electrically induced sensory inputs through TES with task-related trunk training (TRTT) in a home-based program would induce earlier and/or greater improvement in trunk muscle strength, seated reaching distance, trunk control and quality of life (QOL) when compared with placebo TES and TRTT, or control with no active treatment in subjects with chronic stroke. A pilot study and a main study were undertaken for this thesis. The pilot study examined the test-retest and intra-rater reliability of Trunk Impairment Scale (TIS) to be used in the main study. A convenience sample of 16 subjects with chronic stroke (l0 males, 6 females, mean age 69.5 ± 10.7 years) with history of stroke for more than 6 months (post stroke: 65.1 ± 36.7 months) were recruited from a local elderly day care centre. The TIS score with static sitting balance (SSB) subscore, dynamic sitting balance (DSB) subs core and coordination (CO) subscore were assessed simultaneously by 2 physiotherapists for inter-rater reliability. Each subject was reassessed by the same 2 physiotherapists within 1 week for test-retest reliability. Good inter-rater reliability were found in the assessment of TIS score (ICC3,1 = 0.935-0.980) with SSB subscore (ICC3,1 = 0.848- 0.874), DSB subscore (ICC3,1 = 0.961-0.987) and CO subscore (ICC3,1 = 0.970-1.000). Good test-retest reliability were also demonstrated in the assessment of TIS score (ICC2,1 = 0.929-0.948) with SSB subscore (ICC2,1 = 0.776-0.901), DSB subscore (ICC2,1 = 0.913-0.927) and CO subscore (ICC2,1 = 0.789-0.821). The conclusion was that TIS score with SSB subscore, DSB subscore and CO subscore is reliable outcome measure to be used on subjects with chronic stroke in the community. The main study compared the relative effectiveness of 3 treatment protocols: (1) transcutaneous electrical stimulation and task-related trunk training (TES+TRTT), (2) placebo transcutaneous electrical stimulation and task-related trunk training (pTES+TRTT) and, (3) control without any active treatment. A randomized placebo controlled trial of 37 subjects with chronic stroke (27 males, 10 females, mean age 57.8 ± 9.4 years old) with history of stroke of more than 6 months (post stroke: 44.2 ± 28.3 months) and had been discharged from all rehabilitation services for more than 3 months were recruited in the main study. The subjects were randomly assigned to either one of the three 6-week home-based intervention groups: (1) TES+TRTT group, (2) placebo TES+TRTT group, or (3) control group without active training. The subjects in TES+TRTT group received 60 minutes of TES (frequency: 100 Hz, intensity sensory threshold without visible muscle contraction) with 2 pairs of electrodes over their latissimus dorsi (LD) and external abdominus obliquus (EO) muscles of the affected side. Subjects performed TRTT during TES treatment for 5 days/week over a 6-week period at home under the instruction of a physiotherapist. The daily exercise compliance of the training was monitored by the carer. The subjects were required to fill in an exercise log book to record daily exercise compliance. The outcome measures in the thesis included (1) isometric peak trunk flexion torque (PTFT) and isometric peak trunk extension torque (PTET), (2) forward seated reaching (FSR) distance, lateral seated reaching to affected side (LSRA) distance, lateral seated reaching to non affected side (LSRN) distance, (3) TIS score with SSB subscore, DSB subscore and CO subscore, and (4) Physical Component Summary (PCS) score and Mental Component Summary (MCS) score in QOL in the subjects with chronic stroke. The outcome measures were assessed at baseline (A0), after 3 weeks (A1) and 6 weeks (A2) of training, and 4 weeks (Afu) post training. The results showed no significant difference among the groups at baseline (A). After the intervention, the TES+TRTT had significantly earlier and greater improvement in mean change of TIS score at A1 and CO subscore from A1 to Afu, and PCS score at A2 than pTES+ TRTT group. Both TES+TRTT and pTES+TRTT groups had significantly greater improvement in mean change of PTFT from A1 to A2, PTET from A1 to Afu, LSRA from A2 to Afu, LSRN from A2 to Afu, TIS score from A1 to Afu, DSB subscore from A1 to Afu, CO subscore from A1 to Afu and PCS score from A1 to Afu than control group. In summary, this study revealed that the TES+TRTT groups had earlier and greater improvement in mean change of TIS score, CO subscore and PCS score than pTES+TRTT group. The TRTT plays a key role in improving PTFT, PTET, seated reaching distance, TIS score with DSB subscore and CO subscore, and PSC score in QOL. To conclude, this thesis demonstrated that a home-based program with carer support involving TRTT and TES are beneficial to subjects with chronic stroke. Combining TES with TRTT is more superior to placebo TES+TRTT or those without receiving treatment in improving trunk control and physical health status in subjects with chronic stroke. |
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| Access: | restricted access |
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