Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on Spasticity in Adult Patients With Spastic Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      Background: Cerebral palsy (CP) is a neurodevelopmental disorder caused by damage of the
      developing brain and marked by impairments such as increased muscle tone. Physical therapy
      (PT) is an important element for spasticity management include some modalities as
      transcutaneous electrical nerve stimulation (TENS).

      Purpose: To determine the effect of TENS on inhibition of upper limb spasticity in adult
      patients with spastic cerebral palsy.

      Methods: Twenty-four adult spastic CP patients aged from 18 to 45 years old with grade 2 to 3
      spasticity according to Modified Ashworth Scale will be randomly assigned into two equal
      groups: TENS group and conventional therapy group. Both groups will receive conventional
      therapy, while TENS group in addition will receive TENS over elbow flexors with parameter
      setup of (pulse frequency= 100 Hz, pulse duration= 250 μs, time=30 mints) 3 sessions per week
      for successive 4 weeks.

      Outcome measures: Modified Ashworth scale for the spasticity and digital goniometer for elbow
      joint range of motion, Barthel index scale for upper limb activity of daily living. Follow-up
      measures will be calculated three times (preintervention, post 2 weeks, and post 4 weeks).
    


Intervention name(s): Transcutaneous Electrical Nerve Stimulation (TENS); Conventional physiotherapy treatment
Intervention type(s): Device; Other
Intervention description(s): Put the patient in comfort position as long sitting on bed with a supported back and a pillow under the forearm, clean the skin by alcohol swab, setup the parameter, put a gel on electrodes then placed the negative electrode (black wire) over biceps belly and positive electrode (red wire) 3 cm distally from negative electrode , turn on TENS device .
With increase the intensity gradually until patient feel a tingling sensation (no muscle contraction) and every 10 minutes ask patient about the feeling until complete 30 minutes.; Application of a hot pack for 20 minutes to enhance muscle flexibility and get overall spastic muscle relaxation. Anti-spastic muscles (elbow extensors) facilitation: tapping followed by movements (three sets of 15 repetitions per session). Hand weight-bearing with bodyweight (two 5-minute per session). Passive stretching of tight muscles (elbow flexors) is used (this must be a slow and gradual stretch for 20 seconds, followed by 20 seconds of rest, five times per session). Upper-limb active exercises should be done gradually. include (finger flexion and extension exercises, elbow and shoulder (three sets of 20 reps for each session).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There will be 2 groups one is control group will receive a conventional physiotherapy treatment and the second group will receive a conventional physiotherapy treatment plus TENS therapy.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cerebral palsy; Adult; Spasticity; Transcutaneous electrical nerve stimulation; TENS; Conventional therapy