Effects of Transcutaneous Electrical Nerve Stimulation and Functional Electrical Stimulation on Spasticity, Mobility and Gait Parameters in Stroke Survivors.

Title: Effects of transcutaneous electric stimulation and functional electric stimulation on spasticity, mobility and gait parameters in stroke survivors. Aim: To find the effect of Transcutaneous electrical stimulation and Functional electrical stimulation on spasticity mobility and gait parameters in stroke patients. Objectives: To compare the effect of Transcutaneous electrical stimulation and Functional electrical stimulation on spasticity, mobility and gait parameters in stroke patients. Need Of Study :Spasticity is often managed using physical therapy interventions, pharmacologic agents, and surgical procedures. The phenomenon of spasticity is known to be because of hyperexcitability of the stretch reflex mediated by Ia afferents due to loss of inhibition from dorsal reticulospinal tract.

TENS has been hypothesized to modulate spasticity by various mechanisms such as modulation of reciprocal inhibition, reducing stretch reflex excitability, and increasing presynaptic inhibition. Evidence from studies on individuals without stroke shows that TENS can reduce corticomotor excitability of the stimulated regions, thus modulating brain plasticity. Based on the different mechanisms stated above, TENS may be applied over the spastic muscle, or its antagonist, or along the course of the nerve, or distal to the spastic muscle such as on acupuncture points. TENS is cost-effective, can be self-administered, and has fewer side effects than other treatments for spasticity. It can be used for managing spasticity at home, making it a promising alternative or adjunct to current standard therapies.

FES activates several muscles electrically in a coordinated and sequenced manner via nerve fibres to produce a particular function. FES has been applied in varied contexts such as gait training, muscle re-education, and spasticity suppression.Given that both may reduce spasticity, the objective of this study was to compare TENS and FES and measure the duration of after effects on spasticity, mobility and quality of life in stroke patients. Moreover, we incorporated outcomes such as the modified Ashworth scale as assessment tool for spasticity, SS-QOL scale for assessing quality of life, time up and go test for the mobility. Also there are only few studies are present related to this topic in stroke patients.

NULL HYPOTHESIS: • Effects of Transcutaneous electrical stimulation and functional electrical stimulation is equally effective on spasticity, mobility and gait parameters in stroke patients. ALTERNATIVE HYPOTHESIS: •H1: Effect of Transcutaneous electrical stimulation is more effective than functional electrical stimulation on spasticity, mobility and gait parameters in stroke patients. •H2: Effect of Functional electrical stimulation is more effective than transcutaneous electrical stimulation on spasticity, mobility and gait parameters in stroke patients. Materials and Methodology :  -Study design: Experimental                                                             -Study setting: Dr. D. Y. Patil medical college and hospital. -Target Population : Stroke Patients                                                                           Dr. D. Y. college of physiotherapy,pune. -Sample Population: age 30 and above                                          -Sampling method: Purposive -Sample Size : 50 

Introduction :•  Stroke is the third cause of mortality in the world. Stroke results in movement problems like spasticity, atypical pattern of movement, compensatory strategies which lead to functional limitations and disability. Hemiplegia or hemiparesis i.e., paralysis/weakness of one side of the body is the most common presentation of stroke. The phenomenon of spasticity is known to be because of hyperexcitability of the stretch reflex mediated by Ia afferents due to loss of inhibition from dorsal reticulospinal tract• TENS has been hypothesized to modulate spasticity by various mechanisms such as modulation of reciprocal inhibition, reducing stretch reflex excitability, and increasing presynaptic inhibition. Evidence from studies on individuals without stroke shows that TENS can reduce corticomotor excitability of the stimulated regions, thus modulating brain plasticity. 

• TENS is cost-effective, can be self-administered, and has fewer side effects than other treatments for spasticity. FES therapy is associated with neuroplasticity post stroke and thus can contribute to neural recovery.• The Stroke Rehabilitation Evidence-Based Review states there is evidence (i.e., findings supported by a meta-analysis or at least 2 randomized controlled trials) that FES improves upper extremity function, prevents the development of shoulder subluxation, and decreases spasticity and, when combined with gait retraining, can improve gait performance.

Procedure:    The participants were included as per the inclusion criteria and divided into two groups as Group A and Group B. This study will be conducted for the 3 consecutive weeks and 4 sessions per week in which two groups will be created in which one group will get TENS for 30 mins and conventional therapy and other group will get FES for 30mins and conventional therapy. Each group will get the protocol for 60 mins with modality and conventional therapy. The outcome measures for this study will be the Modified modified Ashworth scale, Modified Tardieu scale, Time up and Go test, H-reflex, Ankle ROM and Dynamic gait index measuring scale.