[논문]Effects of Transcutaneous Electrical Nerve Stimulation depending on Frequency and Intensity for Postural Sway during Sit to Stand with Stroke Patients

Byun, Dong-Uk; Shin, Won-Seob

Effects of Transcutaneous Electrical Nerve Stimulation depending on Frequency and Intensity for Postural Sway during Sit to Stand with Stroke Patients 원문보기

대한물리치료학회지 = The journal of Korean Society of Physical Therapy, v.25 no.3, 2013년, pp.136 - 142

Byun, Dong-Uk (Department of Physical Therapy, The Graduate School of Daejeon University) , Shin, Won-Seob (Department of Physical Therapy, College of Natural Science, Daejeon University)

Abstract ▼ AI-Helper

Purpose: The application of transcutaneous electrical nerve stimulation (TENS) is beneficial for joint movements, inhibition of spasticity, and the improvement of walking ability in patients with chronic hemiplegia. This study aimed to identify the effect of the application of TENS to the knee extensor on the affected side with respect to postural-sway distance and velocity during the sit-to stand movement. Methods: We included 19 patients with post-stroke hemiplegia in this study. They underwent measurements during the sit-to stand movement on a force plate with 5 different stimulation dosages applied over 7 s:No TENS, high-frequency and high intensity TENS, high-frequency and low intensity TENS, low-frequency and high intensity TENS, and low-frequency and low intensity TENS The 5 different condition were administered in random order. Results: The group that received TENS application exhibited a significant decrease in path length and average velocity of center of pressure (COP) displacement compared with the group that did not receive TENS application. TENS dosage at low frequency (3Hz) and high intensity yielded a significant decrease in path length, average velocity, mediolateral distance and anteroposterior distance of COP displacement (p<0.05). Conclusion: Our results demonstrated the effectiveness of the application of low-frequency TENS on STS performance. These findings provide useful information on the application of TENS for the reduction of postural sway during the sit-to-stand movement after stroke.

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문제 정의

In conclusion, our results demonstrated the effectiveness of the application of low frequency TENS on STS performance; however, the application of high-frequency TENS was not effective. The results of this study provide evidence that focuses on paretic knee extension to improve STSperformance in individuals with chronic stroke. In order to improve the dynamic balance of stroke patients, stimulation of the low frequency is more effective than highfrequency stimulation of TENS.

제안 방법

This is because the electrical stimulation induced the activation of mechanoreceptors in weight-bearing joints.²⁵ Low-frequency electrical stimulation was applied in this study. Therefore, we assumed that it affected the primary motor cortex and supplementary motor area and helped STS performance.
If the participants were not able to perform the STS movement, the height of the chair was raised, to reduce the knee-flexion angle. The first 2 trials were performed to obtain familiarization with the STS movement. An average of 3 subsequent STS trials was used for analysis.
However, the paretic knee extensor has the highest correlation with STS performance in patients with chronic stroke.⁸ Therefore, in this study, we measured the displacement of the COP to determine the effects of TENS on the knee extensor during STS performance.
This study applied a high-intensity electrical stimulation; moreover, the application of high-frequency electrical stimulation affected muscle contraction. Chesterton et al¹⁴ reported that electrical stimulation at high frequency/high intensity induced a tetanic muscle contraction.
To investigate the frequency and intensity of TENS that affect STS performance in patients with hemiplegia, this study measured the average velocity and distance of COP displacement, as well as weight-symmetry ratio. The groups that received TENS had a significant difference in path length and average velocity of COP displacement compared with the group that did not receive TENS.
¹⁷ Human joint movements are activated by muscles and are expressed as 2 planes: anteroposterior and the mediolateral plane.¹⁸ To investigate the stability of the STS performance in this study, we measured COP displacement in these 2 planes.

대상 데이터

Nineteen patients with hemiplegia (16 men and 3 women) volunteered to participate in this study (Table 1). The inclusion criteria used in this study were as follows: 1) ability to perform STS independently, 2) score of 24 points or more on the MMSE-K evaluation without cognitive disabilities, 3) absence of tolerance to the surface electrode, and 4) voluntary participation in the study after receiving a sufficient explanation of the research.

데이터처리

We performed a paired t test to compare the differences between conditions with orwithout the application of TENS. One-way repeated measures ANOVA was used to compare the effects of the 4 TENS conditions (HFHI, HFLI, LFHI, and LFLI). The posthoc Bonferroni method was used.
The Shapiro-Wilk test was used to assess normalization. We performed a paired t test to compare the differences between conditions with orwithout the application of TENS. One-way repeated measures ANOVA was used to compare the effects of the 4 TENS conditions (HFHI, HFLI, LFHI, and LFLI).

이론/모형

For each variable, the mean values of 3 identical trials were used for analysis. The Shapiro-Wilk test was used to assess normalization. We performed a paired t test to compare the differences between conditions with orwithout the application of TENS.
One-way repeated measures ANOVA was used to compare the effects of the 4 TENS conditions (HFHI, HFLI, LFHI, and LFLI). The posthoc Bonferroni method was used. A significance level of 0.

성능/효과

In conclusion, our results demonstrated the effectiveness of the application of low frequency TENS on STS performance; however, the application of high-frequency TENS was not effective. The results of this study provide evidence that focuses on paretic knee extension to improve STSperformance in individuals with chronic stroke.
In this study, LF yielded a significant decrease in the path length and average velocity of the COP compared with HF. This seems to be represented by the activation of a different central nervous system because of the different frequency of electrical stimulation.
In this study, the LFLI and LFHI conditions yielded a significant decrease in the path length, mediolateral distance, anteroposterior distance, and average velocity of the COP. In accordance with previous studies, the application of TENS contributed significantly to the decrease in the path length and average velocity of the COP.
05). The results of this study showed an effect on STS performance of low frequency, high-intensity TENS compared with high-frequency TENS. In general, STS performance can be divided into 4 stages.

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