Effectiveness of Transcutaneous Electrical Nerve Stimulation with Taping for Stroke Rehabilitation

 

I had kinesio taping on my shoulders but no clue if it did anything.

Effectiveness of Transcutaneous Electrical Nerve Stimulation with Taping for Stroke Rehabilitation

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Tae-Sung In,¹ Jin-Hwa Jung,² Kyoung-Sim Jung,¹ and Hwi-Young Cho³

¹Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea

²Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea

³Department of Physical Therapy, Gachon University, Incheon, Republic of Korea

Academic Editor: Ping Zhou

Received08 Mar 2021

Revised30 Jun 2021

Accepted12 Aug 2021

Published25 Aug 2021

Abstract

Background. 

Spasticity is a factor that impairs the independent functional ability of stroke patients, and noninvasive methods such as electrical stimulation or taping have been reported to have antispastic effects. The purpose of this study was to investigate the effects of transcutaneous electrical nerve stimulation (TENS) combined with taping on spasticity, muscle strength, and gait ability in stroke patients.  

Methods. 

From July to October 2020, 46 stroke patients with moderate spasticity in the plantar flexors participated and were randomly assigned to the TENS group (

) and the TENS+taping group (). All subjects performed a total of 30 sessions of functional training for 30 min/session, 5 days/week, for 6 weeks. For therapeutic exercise, sit-to-standing, indoor walking, and stair walking were performed for 10 min each. In addition, all participants in both groups received TENS stimulation around the peroneal nerve for 30 min before performing functional training. In the TENS+taping group, taping was additionally applied to the feet, ankles, and shin area after TENS, and the taping was replaced once a day. The composite spasticity score and handheld dynamometer measurements were used to assess the intensity of spasticity and muscle strength, respectively. Gait ability was measured using a 10 m walk test.  

 

Results. 

 

The spasticity score and muscle strength were significantly improved in the TENS+taping group compared to those in the TENS group (

). A significant improvement in gait speed was observed in the TENS+taping group relative to that in the TENS group (). 

Conclusions. 

Thus, TENS combined with taping may be useful in improving spasticity, muscle strength, and gait ability in stroke patients. Based on these results, an additional application of taping could be used to enhance the antispastic effect of TENS or other electrical stimulation treatments in the clinic. A long-term follow-up study is needed to determine whether the spasticity relieving effect persists after taping is removed.

1. Background

Stroke is a disease in which brain function is impaired due to a sudden interruption of blood supply to the brain tissue [1]. In stroke patients, the ability of the central nervous system to control the affected side is compromised, the coordination of agonist and antagonist muscles deteriorates, and proprioception and balance control are impaired [2]. In addition, it has been reported that 36%–70% of stroke patients experience spasticity [3, 4], which negatively impacts their functional recovery and results in poor quality of life [5, 6]. In particular, spastic hypertonia of the plantar flexor muscles can cause abnormal gait related to equinovarus foot deformity [7].

Various types of physical therapy interventions, antispastic drugs, and surgical interventions have been used to treat spasticity induced by stroke [8]. Physical therapy interventions include positioning training, stretching, thermotherapy, cryotherapy, facilitatory or inhibitory techniques of voluntary activity, hydrotherapy, vibratory stimulation, electrical stimulation, and acupuncture [9, 10]. Functional electrical stimulation (FES) and transcutaneous electrical nerve stimulation (TENS) are known to have antispastic effects on patients with certain neurological deficits. These interventions also have the advantage of being noninvasive, atraumatic, and easily applicable when compared to acupuncture. In a recent study, relief of spasticity in patients with spinal cord injury was observed for 4 h following 30 min of FES and TENS application, and it was reported that there was no significant difference between the two methods [11]. However, in the case of FES, there is insufficient evidence regarding its ability to reduce spasticity, especially in patients with stroke [9, 12, 13]. Recently, many studies have reported that TENS [14, 15] and taping [16–18] are effective interventions for the management of spasticity associated with neurological disorders. TENS is known to regulate spasticity through various mechanisms, such as by increasing presynaptic inhibition or by reducing the excitability of stretch reflexes [19]. According to a meta-analysis study of the effects of TENS on spasticity, TENS application over nerve or muscle belly in stroke patients for more than 30 min had a strong therapeutic effect on improving spasticity [20]. Tinazzi et al. demonstrated that corticomotor excitability of the area to which TENS was applied was reduced, suggesting that electrical stimulation applied to the somatic area may affect and regulate brain plasticity [21]. However, the application time of electrotherapy is approximately only 30 min/day. As the expression of titin and collagen is different in spastic muscles [22], maintaining the muscle length in a shortened state can change the microstructure over a short period of time [23, 24]. Therefore, additional therapeutic treatments are needed to further enhance and maintain the antispastic effects of TENS.

Recently, other treatments such as stretching, casting, and taping have been applied to enhance the effect of botulinum toxin on reducing spasticity, and taping has been reported to be more effective than electrotherapy or stretching [17]. In a recent study that applied taping to increase the efficacy and effect duration of botulinum toxin injection, it was reported that taping was more effective than stretching exercises. The authors suggested that taping could strengthen the internalization of botulinum toxin type A as it continuously stretches the muscle, thereby exerting a positive effect on the viscoelastic properties of spastic muscles [25].

To date, several studies have reported the synergistic effects of taping and botulinum toxin; however, whether or not taping could enhance the antispastic effect of TENS has not been studied. Therefore, this study is aimed at investigating the effects of TENS combined with taping on spasticity, muscle strength, and gait ability in stroke patients. We applied TENS and functional training to both the experimental and control groups to confirm the antispastic effect of TENS, and the experimental group additionally received taping. We hypothesized that the TENS application reduces spasticity, while the additional application of taping around the ankle joint further enhances the antispastic effect and improves muscle strength and gait ability in stroke patients.