Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial

Reem M Alwhaibi; Noha F Mahmoud; Hoda M Zakaria; Walaa M Ragab; Nisreen N Al Awaji; Mahmoud Y Elzanaty; Hager R Elserougy

doi:10.3390/healthcare9050614

Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial

Healthcare (Basel). 2021 May 20;9(5):614. doi: 10.3390/healthcare9050614.

Authors

Reem M Alwhaibi¹, Noha F Mahmoud¹, Hoda M Zakaria², Walaa M Ragab^{2

3}, Nisreen N Al Awaji⁴, Mahmoud Y Elzanaty^{2

5}, Hager R Elserougy⁶

Affiliations

¹ Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.
² Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt.
³ Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia.
⁴ Health Communication Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.
⁵ Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Deraya University, New Menya 11159, Egypt.
⁶ Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt.

Abstract

Inability to use the affected upper extremity (UE) in daily activities is a common complaint in stroke patients. The somatosensory system (central and peripheral) is essential for brain reorganization and plasticity. Neuromuscular electrical stimulation is considered an effective modality for improving UE function in stroke patients. The aim of the current study was to determine the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) acupoints on cortical activity and the motor function of the affected UE in chronic stroke patients. Forty male and female patients diagnosed with stroke agreed to join the study. They were randomly assigned to group 1 (G1) and group 2 (G2). G1 received task-specific training (TST) and sham electrical stimulation while G2 received TST in addition to TENS acupoints. Session duration was 80 min. Both groups received 18 sessions for 6 successive weeks, 3 sessions per week. Evaluation was carried out before and after completion of the treatment program. Outcome measures used were the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the box and block test (BBT) as measures of the motor function of the affected UE. Brain activity of the motor area (C3) in the ipsilesional hemisphere was measured using a quantitative electroencephalogram (QEEG). The measured parameter was peak frequency. It was noted that the motor function of the affected UE improved significantly post-treatment in both groups, while no significant change was reported in the FMA-UE and BBT scores post-treatment in either G1 or G2. On the other hand, the activity of the motor area C3 improved significantly in G2 only, post-treatment, while G1 showed no significant improvement. There was also significant improvement in the activity of the motor area (C3) in G2 compared to G1 post-treatment. The results of the current study indicate that TST only or combined with TENS acupoints can be considered an effective method for improving motor function of the affected UE in chronic stroke patients, both being equally effective. However, TST combined with TENS acupoints proved better in improving brain plasticity in chronic stroke patients.

Keywords: motor impairment; quantitative electroencephalogram; stroke; task-specific training; transcutaneous electrical nerve stimulation acupoints; upper extremity.

Grants and funding

RGP-1440-0012/Princess Nourah Bint Abdulrahman University