The influence of Task-Related Training combined with Transcutaneous Electrical Nerve Stimulation on paretic upper limb muscle activation in patients with chronic stroke

Article type: Research Article

Authors: Jung, Kyoungsim^{a; 1} | Jung, Jinhwa^{a; 1} | In, Taesung^b | Kim, Taehoon^{c; 2; *} | Cho, Hwi-young^{d; 2; *}

Affiliations: [a] Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea | [b] Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea | [c] The Post-Professional DPT Program, Stockton University, New Jersey, USA | [d] Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea

Correspondence: [*] Address for correspondence: Taehoon Kim, P.T., Ph.D., The Post-Professional Doctor of Physical Therapy Program, Stockton University, 101 Vera King Farris Drive, Galloway, NJ 08205-9441, USA. Tel.: +1 201 870 5401; Fax: +1 646 478 9778; E-mail: dongju9475@hanmail.net and Hwi-young Cho, P.T., Ph.D., Department of Physical Therapy, College of Health Science, Gachon University, 191, Hambangmoe-ro, Yeonsu-gu, Incheon, 406-799, Republic of Korea. Tel.: +82 32 820 4560; Fax: +82 32 820 4420; E-mail: hwiyoung@gachon.ac.kr.

Note: [a] These two authors contributed equally to this study as co-first author.

Note: [b] Two authors have contributed equally to this work as corresponding author.

Abstract: OBJECTIVES: This study investigated the efficacy of Task-Related Training (TRT) Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis. METHODS: A single-blind, randomized clinical trial was conducted with 46stroke survivors with chronic paresis. They were randomly allocated two groups: the TRT+TENS group (n = 23) and the TRT+ placebo TENS (TRT+PLBO) group (n = 23). The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors, while the TRT+PLBO group received placebo TENS that was not real ES. Both groups did 30 minutes of TRT after TENS application. Intervention was given five days a week for four weeks. The primary outcomes of upper limb muscle activation were measured by integrated EMG (IEMG), a digital manual muscle tester for muscle strength, active range of motion (AROM) and Fugl-Meyer Assessment of the upper extremity (FMA-UE). The measurements were performed before and after the 4 weeks intervention period. RESULTS: Both groups demonstrated significant improvements of outcomes in IEMG, AROM, muscle strength and FMA-UE during intervention period. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvement in muscle activation (wrist extensors, P = 0.045; elbow extensors, P = 0.004), muscle strength (wrist extensors, P = 0.044; elbow extensors, P = 0.012), AROM (wrist extension, P = 0.042; elbow extensors, P = 0.040) and FMA-UE (total, P < 0.001; shoulder/elbow/forearm, P = 0.001; wrist, P = 0.002; coordination, P = 0.008) at the end of intervention. CONCLUSIONS: Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.

Keywords: Transcutaneous Electrical Nerve Stimulation (TENS), arm motor function, Task–Related Training

DOI: 10.3233/NRE-161419

Journal: NeuroRehabilitation, vol. 40, no. 3, pp. 315-323, 2017