Investigating the Impact of Transcutaneous Electrical Nerve Stimulation on Upper Extremity Motor Function for Patients Post-Stroke: A Systematic Review
Loading...
Date
2024-03
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Stroke continues to be a leading cause of disability in the United States largely due to unilateral motor deficits which create a significant barrier to daily functional abilities. Several therapists in the outpatient rehabilitation setting utilize various motor retraining interventions such as neuromuscular electrical stimulation; however, these interventions may be missing a crucial component in motor recovery: somatosensory stimulation. Transcutaneous electrical nerve stimulation (TENS) provides constant sub-motor threshold stimulation that helps the brain reintegrate crucial information regarding the tactile sensation and the body’s position in space via the afferent pathway.
Objective: To investigate the impact of upper extremity (UE) TENS on motor recovery outcomes in patients in the subacute to chronic stages of stroke recovery.
Search Method: Pre-selected search terms were entered into various peer-reviewed research databases including PubMed, CINAHL, Embase, and SCOPUS. Articles from each search were imported into a reference manager where all duplicates were removed.
Selection Criteria: Inclusion criteria consisted of peer-reviewed, randomized control trials conducted with adult post-stroke patients in the subacute to chronic stages in the outpatient rehabilitation setting utilizing UE TENS as the primary intervention.
Data Extraction and Analysis: Two reviewers independently voted to include/exclude each article, and conflicts were resolved by a third independent reviewer. Each included article was assessed for methodological quality and individual risk of bias. Finally, the quality of evidence and strength of recommendation were determined by evaluating each outcome across studies.
Results: Of 1422 studies screened, 6 randomized control trials met the inclusion criteria and were included in the present review. Each of the studies paired UE TENS with a version of task- specific training. All but one study found a significant difference between experimental and control groups for at least one of the UE motor function outcomes measured, favoring the TENS group(s). Of the 6 included studies, 2 were assigned a 2a level of evidence, and the remaining 4 were assigned a 2b level of evidence. 5 of the studies received an overall rating of low risk of bias and 1 study received an overall rating of high risk. The use of TENS was given a low- moderate quality of evidence supporting its use for improving UE motor function and received an overall recommendation rating of Weak+. The evidence revealed the following as potentially the most effective active ingredients: high-frequency TENS for 30-60 minutes 3-5 times per week with electrode placement proximally (over elbow/wrist extensors) as well as distally (over the hand and fingers) and paired with task-specific training.
Implications: The results of this systematic review indicate that the use of UE TENS for hemiparetic post-stroke patients may be an effective intervention to expedite UE motor recovery; however, further research is needed to determine to most effective electrode placement, length/frequency of stimulation, time of stimulation (before, during, or after task-specific training), and stage of recovery to provide TENS intervention.
Description
Poster Division: Biological & Health Sciences: 3rd Place (The Ohio State University Edward F. Hayes Advanced Research Forum)
Keywords
Stroke, Somatosensory Electrical Stimulation, TENS, Occupational Therapy, Upper Extremity Motor Recovery, Neuromuscular Re-Education