Table 5.
Characteristics of studies using Transcutaneous Electrical Nerve Stimulation (TENS) for the treatment of triceps spasticity after stroke.
| Author | Sample | Intervention and dosage | Comparator | Outcomes |
Follow-up (months) |
Within group difference (over the time) |
Between group difference after treatment |
|---|---|---|---|---|---|---|---|
| Koyama et al. (49) | 20 patients with spasticity | 30-min TENS (50/100/200 Hz) on the peroneal nerve (0.25 ms, 40 s ON/10 s OFF) One single session |
n.a. | Reciprocal Inhibition (RI), Presynaptic Inhibition (PI) H-reflex latency |
n.a. | PI ↑ RI, H-reflex ↔ |
n.a. |
| Picelli et al. (50) (RCT) | 30 (10/10/10 IG1/IG2/IG3) patients with spasticity for at least 6 months (MAS>1) | IG1: 15-min TENS (100 Hz, 0.3 ms) on the tibialis nerve Five days a week, for 2 weeks |
IG2: 10-min continuous ultrasounds on the triceps, 5 days a week for 2 weeks IG3: BoNT-A injections in the gastrocnemius |
MAS pROM |
3 | IG1: MAS, pROM ↔
IG2: MAS, pROM ↔ IG3: MAS ↓ pROM ↑ |
MAS, pROM§ (IG3) |
| Cho et al. (51) | 42 (22/20 IG/CG) patients with spasticity for at least 6 months | 30-min Bobath rehabilitation + 60-min TENS (100 Hz, 0.2 ms) on the gastrocnemius One single session |
CG: 30-min Bobath rehabilitation + sham TENS | MAS Plantarflexors resistance (PR) Postural sway length |
One day | IG: MAS, PR, Postural Sway Length ↓
CG: MAS, HHD, Postural Sway Length ↓ |
MAS, PR, Postural sway length† (but non at follow-up) |
| Martins et al. (52) (RCT) | 20 patients with spasticity for at least 6 months (MAS ≥ 1) | IG1: 30-min TENS (100 Hz, 0.06 ms) on the posterior tibialis nerve One single session |
IG2: 30-min cryotherapy (applied at the same group the following day) CG: 40 assessments of non-affected limbs before treatment |
H/M ratio H-reflex latency, Tibialis anterior EMG activity |
n.a. | IG1: H/M ratio ↓
H-reflex latency, Tibialis anterior EMG ↔ IG2: H/M ratio, H-reflex latency ↑ Tibialis anterior EMG ↔ CG: H/M ratio, H-reflex latency, Tibialis anterior EMG ↔ |
H/M ratio+ (CG) H-reflex latency§ (IG2) |
| Yan and Hui-Chan (53) (RCT) | 56 (19/19/18 IG/CG1/CG2) patients with acute stroke (< 10 days) | 60-min usual rehabilitation + 60-min TENS (100 Hz, 0.2 ms) on the acupuncture points of the lower limb Five days a week, for 3 weeks |
CG1: 60-min usual rehabilitation + sham TENS CG2: 60-min usual rehabilitation only |
Composite Spasticity Scale (CSS) MIVC of tibialis anterior and gastrocnemius, co-contraction of plantarflexors, TUG |
2 | IG: CSS, MIVC ↑ (CSS increased less than the other groups) TUG, co-contraction ↓ CG1: CSS, MIVC ↑ TUG, co-contraction ↓ CG2: CSS, MIVC ↑ TUG, co-contraction ↓ |
MIVC, TUG, co-contraction† |
| Ng and Hui-Chan (54) (RCT) | 80 (19/21/20/20 IG1/IG2/CG1/CG2) patients with spasticity for at least 1 year (CSS ≥ 10) | IG1: 60-min TENS (100 Hz, 0.2 ms) IG2: 60-min TENS (100 Hz, 0.2 ms) + 60-min task-related training Five days a week, for 1 month |
CG1: Sham TENS + 60-min task-related training CG2: No intervention |
Composite Spasticity Scale (CSS) MIVC of dorsiflexors and plantarflexors, Gait velocity |
1 | IG1: CSS ↓
MIVC, velocity ↑ IG2: CSS ↓ MIVC, velocity ↑ CG1: CSS ↓ MIVC, velocity ↑ CG2: CSS, velocity ↔ MIVC ↑ |
CSS † (IG1, IG2) MIVC† (IG2) Velocity† (IG2) |
Statistically significant increase.
Statistically significant decrease.
No statistical difference.
IG overcomes comparator (listed in brackets when multiple).
Comparator overcomes IG (listed in brackets when multiple).
IG, Intervention Group; CG, Control Group; n.a., not available; RCT, Randomized Controlled Trial; TENS, Transcutaneous Electrical Stimulation; PI, Presynaptic Inhibition; RI, Reciprocal Inhibition; MAS, Modified Ashworth Scale; BoNT-A, Botulinum Neurotoxin Type-A; pROM, passive Range of Motion; PR, Plantarflexors Resistance; EMG Electromyography; CSS, Composite Spasticity Scale; MIVC, Maximum Isometric Voluntary Contraction; TUG, Timed Up and Go.