Effect of Tecar in Addition of Functional Massage in Post-stroke Spasticity

Not Applicable

Completed

• Conditions: Stroke Sequelae; Spasticity, Muscle; Electrotherapy; Massage
• Interventions: Device: Sham Tecar Therapy; Device: Tecar Therapy

• Registration Number: NCT04824768
• Lead Sponsor: Universitat Internacional de Catalunya

Brief Summary

Spasticity is due to an abnormal processing of a normal input from muscle spindles in the spinal cord.

Detailed Description

Stroke often affects sensory-motor networks and descending tracts, as reflected by several signs of upper motor neuron syndrome. One symptom is post-stroke spasticity. It is due to an abnormal processing of a normal input from muscle spindles in the spinal cord. It is often defined by a velocity-dependent increase in muscle tone and a resistance to passive muscle stretch. It has neural (increased reflex activity) and non-neural (altered visco-elastic properties due to immobilization) components. The prevalence of spasticity ranges from 25%-43% at 6 months post-stroke. Chronic spasticity can decrease the number of sarcomeres. As a result, the proportion of connective tissue in the muscle and fasciae can increase. These subjects present fibrosis that have augmented passive muscle stiffness due to structural and functional adaptations inside the muscle cells. Soft tissue changes may cause the pulling forces to be transmitted more readily to the muscle spindles, which can intensify sensory input thus increasing spasticity. It has a potential impact on lower limb function, which affects passive muscle stretch, range of motion, and motor unit recruitment during voluntary contraction. In the stance phase of gait, the deformity also produces an inadequate base of support, which is associated with balance impairments. This increases the risk of falls, reduces patient participation in daily activities, and decreases health-related quality of life. Physiotherapy treatments of spasticity aim to decrease excessive muscular tone, ease mobility, give the patient the sense of right position and avoid joint limitations.

Functional massage is a non-invasive manual therapy technique that combines rhythmical passive joint mobilization with compression and decompression of the muscular belly with the tendinomuscular insertions to treat. It is indicated in cases of muscle stiffness associated with pain.

Tecar therapy or Capacitive Resistive Electric Transfer Therapy (CRet) is a non-invasive diathermy technique which provides high frequency energy (300 KHz-1.2 MHz) generating a thermal effect on soft tissues. CRet is used to facilitate tissue regeneration, and it does not need a surface-cooling system, as its wave frequency is lower than in conservative diathermy. CRet effectiveness has been evaluated in several studies. It is effective in the treatment of chronic musculoskeletal disorders, where a temperature increase on deep tissues is needed in order to generate changes on its viscoelasticity. This effect may be beneficial in the spasticity treatment since spasticity onset and development may be affected by structural changes in muscular and tendinous fibers.

No studies on the effects of CRet in post-stroke spasticity treatment were found.

Study Timeline

• Study First Submitted: 2021-03-27
• Study First Submitted QC: 2021-03-27
• Study First Posted: 2021-04-01
• Study Start: 2021-05-20
• Primary Completion: 2022-04-29
• Study Completion: 2022-05-26
• Status Verified: 2023-03
• Last Update Submitted: 2023-03-28
• Last Update Posted: 2023-03-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 36

Inclusion Criteria

• Diagnosis of Stroke
• Scoring 1 on the Modified Ashworth Scale (MAS) for hip or/and knee flexion or/and ankle dorsiflexion on the most affected limb
• Scoring 25 or plus on the Montreal Cognitive Assessment (MoCA)

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Exclusion Criteria

• Having suffered a traumatism on the lower limbs three months, or less, before the intervention
• Suffer other neurological disease
• Presence of osteosynthetic material
• Pacemaker wearing
• Treatment with botulinum toxin or another antispastic medication, six months , or less, before the intervention
• Carry baclofen pump
• Functional inability to adopt the prone or supine position on the treatment table
• Functional inability to sit, stand and walk
• Poor language and communication skills that make difficult to understand the informed consent
• Contraindications to Functional Massage (infectious diseases, inflammatory vascular conditions, acute inflammation, hemorrhagic, fever)

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control group	Sham Tecar Therapy	30 min session of Tecar Therapy with functional massage on the rectus femoris, and gastrocnemius. Sham stimulation was provided by only turn on the device but dose is 0.
Experimental group	Tecar Therapy	30 min session of Tecar Therapy with functional massage on the rectus femoris, and gastrocnemius. Tecar therapy in the resistive modality (80W) on lower back and hamstrings and in rectus femoris and gastrocnemius with resistive mode (100-120W), and then in capacitive mode(180-200VA)

Primary Outcome Measures

Name	Time	Method
Muscle tone	T1: Baseline, T2: Immediately after treatment and T3: follow up 30 minutes after treatment	To evaluate the immediate changes in terms of muscle tone on the rectus femoris, medialis and gastrocnemius after one session with CRet as coadjuvant of functional massage by modified Ashworth Scale of Hip flexion-extension, knee flexion-extension, ankle plantar flexion and dorsiflexion. The minimum and maximum values are 0 and 4, higher scores mean a worse outcome.

Secondary Outcome Measures

Name	Time	Method
Muscle stiffness	T1: Baseline, T2: Immediately after treatment and T3: follow up 30 minutes after treatment	To evaluate muscle stiffness on rectus femoris and gastrocnemius after one session with CRet as coadjuvant of functional massage by mioton Myoton Pro, Myoton Ltds., Estonia) on the muscular belly.
Passive range of motion	T1: Baseline, T2: Immediately after treatment and T3: follow up 30 minutes after treatment	Goniometry applied on passive hip flexion and extension, passive knee flexion and ankle plantar flexion and dorsiflexion with a wedge under the knees. The force applied by the physiotherapist will be recorded with a goniometer and will be applied to the head of the metatarsals.
Muscle relaxation	T1: Baseline, T2: Immediately after treatment and T3: follow up 30 minutes after treatment	Myoton-Pro device applied on the muscle belly of rectus femoris, internal and external gastrocnemius
Muscle flexibility	T1: Baseline, T2: Immediately after treatment and T3: follow up 30 minutes after treatment	Myoton-Pro device applied on the muscle belly of rectus femoris, internal and external gastrocnemius

Trial Locations

Locations (2)

Laura Garcia Rueda; 🇪🇸 Barcelona, Spain

Universitat Internacional de Catalunya; 🇪🇸 Barcelona, Catalonia, Spain