Comparison the Effects of Early Functional Electrical Stimulation and Transcutaneous Electrical Nerves Stimulation in Functional and Motor Recovery for Acute Stroke Patients
Condition: Acute Stroke Intervention
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The purpose of this study was to examine the outcomes of postural stability, activities of
      daily living function, and motor capacity of persons after stroke who received transcutaneous
      electrical nerves stimulation (TENS) or functional electrical stimulation (FES), in addition
      to SR, in the post-stroke acute phase. Such persons were compared with others who received SR
      alone in order to determine if the addition of TENS or FES resulted in earlier or more
      effective recovery.
    

Detailed description: 
      Based on modern knowledge about the neuro-plastic changes that occur immediately after brain
      injuries, rehabilitation should be more effective when started soon after brain damaged.
      Besides, knowledge about one of the factors that determine efficacy of rehabilitation is the
      commencement of treatment, as well as on the time interval from stroke to initiate voluntary
      movement. Therefore, many studies had reported that the effectiveness of functional
      electrical stimulation (FES) and transcutaneous electrical nerves stimulation (TENS), which
      induce stimulation and the excitability, were widely applied in rehabilitation for patients
      with stroke. However, many investigations about the effects of FES or TENS on motor recovery
      for the stroke patients mainly focus on the chronic stage as well as compared each of two
      different kinds of stimulation separately. Hence the investigators will study the impacts of
      TENS and FES on the motor recovery for the stroke patients from the acute stage. Bedsides,
      the investigators also study that whether patients after stroke in the acute stage who
      received adding TENS experienced similar impacts on motor recovery to those who received
      adding FES.

      This was a single-blind randomized control trial study. The study recruited 40 subjects from
      stroke center of National Taiwan Hospital (NTUH) within 3 days after first stroke onset. All
      subjects were in stable medically control and assigned randomly to 1 of 3 groups including
      (1)Functional electrical stimulation (FES) + standard rehabilitation (SR) ,(2) Transcutaneous
      electrical nerves stimulation (TENS) + SR or (3)SR only (control group).The application of
      FES and TENS was used for 30 minutes per day, 5 days per week for 2 weeks. The surface
      electrodes of two dual channels were applied on tibialis anterior and quadriceps for FES and
      TENS group. All groups received SR including neuro-facilitation and functional task training
      etc.

      Outcome measurements were analyzed with repeated measure analysis of variance using SPSS to
      compare the main effects before, during, and after treatment, followed by post-hoc tests with
      Bonferroni correction to compare treatment effects among the 3 groups. For categorical
      variables, a X2 test was used. The significance level was set at 5% (2-tailed).
    

Intervention name(s): functional electrical stimulation (FES); transcutaneous nerve stimulation (TENS); standard rehabilitation (SR)
Intervention type(s): Device; Device; Other
Intervention description(s): Two dual-channel stimulators (MEDTRONIC Respond Select；Empi Inc) were connected with a program timer to form one stimulating unit for functional electrical stimulation (FES). FES was delivered with 0.3-ms pulses at 30 Hz, maximum tolerance intensity about 20 to 30 mA to cause visible muscle contraction.; Transcutaneous nerve stimulation (TENS) stimulator (BioTENS, Skylark Device & Systems Co., Ltd,) was applied with 0.2 ms pulses, at 100 Hz in the constant mode within the subject'sensory level without muscle contraction, via (5 × 3.5 cm) electrodes attached to the motor points of quadriceps and tibialis anterior (TA) on the affected lower extremity.; The standard rehabilitation (SR) program was a part of a regular intervention in stroke center. The activities of SR performed including neurodevelopment facilitation techniques, range of motion exercises and movement re-learning exercises etc.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: acute stroke,TENS ,posture stability, function