IMMEDIATE EFFECT OF TENS ON
SPASTICITY AND BALANCE IN STROKE
PATIENTS.
Submitted by:
REENA VAGHELA (12SPTPT11087)
AVANEE VAJAR (12SPTPT11088)
6th semester, JUNE-2015
Guided by:
DR. NIRAJ KARAMCHANDANI
(M.P.T.musculoskeletal and sports science)
DECLARATION
CERTIFICATE
We hereby certify that we are the authors of this project work. We certify to the best of
our knowledge, our project does not infringe upon anyone’s copyright nor violate any
This is to certify that the project work entitled “IMMEDIATE EFFECT OF TENS ON
SPASTICITY AND LOWER LIMB BALANCE IN STROKE PATIENTS.” has been
undertaken and written under my supervision and it describes the original research work
carried out by REENA VAGHELA AVANEE VAJAR
proprietary rights and that any ideas, techniques, quotations, or any other material from
the work of other people included in our project published or otherwise, are fully
acknowledged in accordance with the standard referencing practices. We declare that
this is a true copy of our project, including any final revisions, as approved by my project
registered at RK University in 6th semester Bachelors of Physiotherapy.
review committee.
Signature of Guide:
Signature.of candidate
Signature.of candidate
Name: Dr. Niraj Karamchandani
Degree: M.P.T.(Ortho)
Designation: Lecturer
Reena vaghela
Avanee Vajar
Enrolment no.: 12sptpt11087
Enrolment no.:12sptpt11088
Date :2
nd
june,2015
Place: Rajkot
I
Date: 2nd june,2015
Place: Rajkot
II
I would like to extend my heartfelt thanks to assistant lecturer, Dr. Shweta Rakholiya
and Dr. Vaibhavi Ved _ for their valuable guidance, constant help and support throughout this
study and all the lecturers of my college who have taught me and gave their valuable suggestions
during the course of the study.
ACKNOWLEGEMENT
My sincere thanks to all stroke patients for taking keen interest in my study, guiding me through
the path, giving me support and motivation during the course of study.
First and foremost I would like to thank our parents and who are my living Gods and my
brother for their valuable support and encouragement, blessing and love which has always been
I wish to express my thanks to our librarian for their timely help in lending me books and
journals for my reference all the time.
I shall fail my duties if I don’t acknowledge my Colleagues and Friends for their
a source of inspiration and strength in accomplishing this academic task.
My heartfelt gratitude to almighty God who has guided me this far and to whom goes all
suggestions and criticism while assisting me in this study
Last but not the least I would like to thanks all the Individuals in my study without whom
the honor and glory for the successful completion of this study.
I wish to express my regards to my Director Dr. Priyanshu Rathod School of
Physiotherapy, R.K.University for her whole hearted guidance and meticulous suggestions in the
completion of this work and for all the facilities and support extended to me during this study. I
am extremely thankful for her constant encouragement and inspiration during the course of this
this task would not have been possible.
My sincere thanks to all the contributors whose names I might have missed but who truly
deserve my gratitude.
I would like to thank once again to all who have helped me all the while.
study.
With due respect, I would like to express my sincere thanks to my guide
Dr. Niraj
KaramchandaniSenior lecturer of School of Physiotherapy, R.K.University, for his judicious
information, expert suggestions, valuable guidance, continuous support, incessant reassurance
during every stage of this work and interest shown in this dissertation without which this work
Signature
would not have been possible.
Name: Reena vaghela
III
Signature
Name: Avanee vajar
IV
ABSTRACT
LIST OF ABBREVIATIONS
BACKGROUND: stroke is a condition in which Spasticity in the body musculature
greatly Affect functional independence of patients.TENS is one of the useful
modality to reduce Spasticity.
1. MAS: Modified ashworth scale
AIM: to find out immediate Effect of TENS on balance performance in Stroke
patientsTo find out the effect of TENS on spasticity In stroke patient.
2. SD: standard deviation
3. TUG: Time up and Go test
METHODOLOGY: Ten chronic stroke subjects were selected for the study for the
above mentioned centres by means of purposive (convenient) sampling. All these
subjects participated in the study voluntarily after signing a consent form. The
demographic data and further assessment was collected from each subjects. The
purpose of study was explained to all the subjects.
4. TENS: Trance cutaneous electricle nerve stimulator
RESULTS: significant result in balance with nonparametric Wilcoxon test but in
spasticity No sigificant difference.
CONCLUSION: On the basis of this study we can say that application of TENS for
single session may not reduce the spasticity but it will improve the balance in chronic
stroke patients.
KEY WORDS: Stroke, Spasticity, Balance, TENS, TUG Test, MAS.
V
VI
LIST OF FIGURES
TABLE OF CONTENTS
SR. NO.
FIGURES
PAGE NO.
6.1
TENS
16
6.2
MATERIALS
16
Sr. No.
TITLE
Page No.
6.3
TENS APPLICATION
17
1.
INTRODUCTION
1
6.4
POST TUG TEST
17
2.
NEED OF STUDY
5
3.
AIMS & OBJECTIVES
7
4.
HYPOTHESIS
9
5.
REVIEW OF LITERATURE
11
6.
METHODOLOGY
13
7.
RESULTS
20
8.
DISCUSSION
24
9.
CONCLUSION
28
10.
SUMMARY
30
11.
BIBLIOGRAPHY
32
12.
ANNEXURES
36
VII
VIII
LIST OF TABLES
Sr. NO.
TABLES
Page No.
7.1
STANDARD DEVIATION AND MEAN OF TUGTEST
23
7.2
WILCOXON FOR TUG TEST
23
7.3
STANDARD DEVIATION AND MEAN FOR MAS
24
LIST OF GRAPHS
SR.
GRAPHS
NO.
PAGE
NO.
7.1
STANDARD DEVIATION AND MEAN FOR TUG TEST
23
7.2
STANDAED DEVIATION AND MEAN FOR MAS
24
INTRODUCTION
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
IX
INTRODUCTION
dizziness, loss of balance or coordination; severe headache with no known
cause; fainting or unconsciousness (WHO).
A stroke is caused by the interruption of the blood supply to the
brain, usually because a blood vessel bursts or is blocked by a clot. This
Spasticity is an involuntary velocity dependent increased muscle
cuts off the supply of oxygen and nutrients to the brain, causing damage to
tone resulting in resistance in movement that result secondary to
the brain tissue. Stroke is a clinical syndrome divided into two broad
stroke.Spasticity results from impaired reflex function and also induces
categories that define its pathophysiology2
changes in rheological muscle properties like stiffness, fibrosis and
atrophy.In lower extremity spasticity is more common in following muscles
Ischaemic strokes are caused by sudden occlusion of arteries
Iliopsoas, ,Adductor longus and brevis, Adductor magnus, Gracilis, Rectus
supplying the brain, either due to a thrombus at the site of occlusion or
femoris, , Gluteus maximus, Medial and lateral gastrocnemius, Tibialis
formed in another part of the circulation.2 Haemorrhagic strokes are
anterior and posterior5,6.
caused by subarachnoid haemorrhage – bleeding from one of the brain’s
arteries into the brain tissue or intra-cerebral haemorrhage - arterial
The effect of spasticity include restriction of volitional activities static
bleeding in the space between meninges2.
posturing of limbs, painful muscle spasm, hyperactive reflexes, abnormal
posture and development of contracture in severe cases. The automatic
Stroke is a global health problem. It is the second commonest cause
adjustment of muscle tone that occurs normally during a movement task is
of death and fourth leading cause of disability worldwide Approximately 20
termed as automatic postural tone. This is impaired in stroke patients.
million people each year will suffer from stroke and of these 5 million will
Thus patients with stroke will lack the ability to stabilize trunk and proximal
not survive . In developed countries, stroke is the first leading cause for
joints appropriately with the resultant postural misalignment, balance
disability, second leading cause of dementia and third leading cause of
impairments7.
death1,3 .
The aim of stretching is to improve the viscoelastic properties of the
Stroke Morbidity and Mortality in India
muscle-tendon unit and to increase its extensibility. Additional therapies,
like hydrotherapy, cryotherapy, thermotherapy, vibratory stimuli or
• Prevalence 90-222 per 100,000 3
neurodevelopmental inhibitory techniques are used to relax muscles and
• 102, 620 million deaths 3
reduce the intensity of spasticity. Orthosis are used for improvement of
function and prevention of contracture and deformity8,9.
The most common symptom of a stroke is sudden weakness or
numbness of the face, arm or leg, most often on one side of the body.
Stimulation methods, such as TENS, ultrasound and transcranial
Other symptoms include: confusion, difficulty speaking or understanding
direct current stimulation, which have, until now, only been used in
speech; difficulty seeing with one or both eyes; difficulty walking,
research9.
2
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
3
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
TENS is another physical treatment that consists of electrical
stimulations administered over the spastic region, the spinal dermatome or
the peroneal nerve Moreover, it has been suggested that TENS could
facilitate cortical synaptic reorganization and motor output by increasing
sensory input, due to the stimulation of large diameter A fibres10.
The efficiency of TENS still needs to be further investigated through
rando- mized controlled trials.
International medical journal of experimental and clinical research
shows that TENS has recently been applied to decrease spasticity and
improve balance and gait in stroke patients.
NEED OF THE STUDY
4
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
5
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
NEED OF THE STUDY
Stroke is a condition in which spasticity in the body musculature greatly affect the
functional independence of the patients. Various studies are done but studies
evaluating the emmediate effect of TENS are very less without definite conclusion.
This study has shown favourable results in reducing spasticity.
In this study an attempt has been made to find out the immediate effect of TENS
on spasticity and lower limb balance in stroke patient.
AIM AND OBJECTIVES
6
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
7
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
AIM & OBJECTIVES
 To find out the Immediate effect of TENS on spasticity and lower limb
balance in stroke patients.
 The immediate effect of TENS on balance performance in stroke
patient by TUG test(timed up and go test).
 The effect of TENS on spasticity in stroke patient by MAS(modified
ashworth scale).
HYPOTHESIS
8
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
9
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
HYPOTHESIS
 ALTERNATE HYPOTHESIS:
There is significant reduction in spasticity on stroke patients using
Transcutaneous Electrical nerve stimulation.
 NULL HYPOTHESIS:
There is no significant difference in spasticity on stroke patients before
and after using Transcutaneous Electrical nerve stimulation
REVIEW OF LITERATURE
10
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
11
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
REVIEW OF LITERATURE
1) Manganotti p n harlaar(2005) et al had studied that single treatment of
shock wave therapy on flexor group of muscle with stroke resulted in
significant reduction of muscle tone that lasted for over three months .Other
physical modalities like ultrasound therapy , cryotherapy , vibration and
electrical stimulation are also effective in reduction of spasticity.
2) Bovend eeredt TJ,selles rw et al (2008) examined the effect of isotonic
and isokinetic muscle stretch on the excitability of spinal alpha motor neuron
and concluded effect of stretching on spasticity It includes several types of
muscle elongation that can be applied by moving the joints through the
range of motion (ROM) manually, or by means of different mechanical
devices, to normalize muscle tone, maintain or increase soft-tissue
extensibility, reduce contracture pain, and improve motor function
3) Donnell et al(2010) had shown that Interheart and Interstroke studies in 22
countries including India identified major risk factors for stroke that
contribute to 90% of stroke in these countries the factors are hypertension,
smoking, alcohol intake, diet, psychological factors and cardiac cause.
4) Ward AB et al.(2012) had done study on prevalence of spasticity and
shown that onset of spasticity is highly variable and can occur in the short
medium or long term post stroke period. that 25% of patients with stroke
suffer from spasticity within the first 6 weeks of the event.
5) Junhyuck park et al (2014) had studied effect of combination of exercise
and TENS in two groups and concluded that A combination of therapeutic
exercise and TENS may reduce spasticity and improve balance, gait, and
functional activity in chronic stroke patients
METHODOLOGY
12
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
13
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
METHODOLOGY

Study Design: Experimental design

Study Setting: Various clinics of Rajkot city

Sampling Technique: Convenient Sampling Technique

Study Population: 40-65 years of stroke patients who can
CRITERIA FOR SELECTION

o Chronic stroke patients which are independent for ambulation (with
or without stick)
o Patients with spasticity in lower limb.
o Both male and female.
ambulate

Study Sample: 10 patients

Study Duration:
INCLUSION CRITERIA
o Age group between40-70 years.

EXCLUSION CRITERIA
 Training duration : single session study
o Bed ridden patient.
 Total Study duration : 14 weeks
o Other neurological condition.
o Unwilling to participate.
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
15
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
MATERIALS USED IN THE STUDY

TENS machine

Chalk

Chair

Measure tape

Stopwatch

Couch
6.3 TENS APPLICATION
6.1 TENS
6.4 POST TUG TEST
6.2 MATERIALS
16
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
17
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
METHOD
This study is completely randomized type of experimental study
design.
Ten chronic stroke subjects were selected for the study for the
various centres of rajkot by means of purposive (convenient) sampling.
All these subjects participated in the study voluntarily after signing a
consent form. The demographic data and further assessment was
collected from each subjects. The purpose of study was explained to all
the subjects. TUG score and MAS was taken befpre TENS application.
Then TENS is applied for 20 minutes to calf muscle with frequency of 200
Hz and pulse width is 0.2 microseconds.
After removal of TENS patient was given 5 minutes rest and then
post TUG scoring and MAS was checked. Post TUG score and MAS are
showing that TUG score was decreased and no change in MAS grading. It
is showing application of TENS in lower limb spasticity will improve
balance.
In stroke patients to decrease spasticity more time required for TENS
application.
18
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
19
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
RESULTS
Resuts were analyzed by SPSS version 16. Where level of significance is
<= 0.05.
Here nonparametric Wilcoxon test is applied for pre –post TUG test and
table no. 7.1 is showing result of TUG. Result of TUG are significant.
7.1 standard deviation and mean for TUG test
N
Mean
Std. Deviation
TUGPRE
10
42.991
7.89739
TUGPOST
10
35.79
7.08009
7.2 Wilcoxon for TUG pre-post
Test Statistics
Z
-2.803a
Asymp. Sig. (2-tailed)
.005
This study is significant?(>/=.05)
Yes
RESULTS
20
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
21
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
7.1 Graphical presentation of standard deviation and mean of TUG.
This study is not showing significant result in MAS Scale.
7.3 standard deviation and mean for MAS.
Y
50
45
42.991
40
Mean
PRE MAS
POST MAS
1.4
1.4
0.84
0.84
35.79
35
Std. Deviation
30
25
Mean
20
10
7.2 Graphical presentation of mean and standard deviation of MAS.
Std. Deviation
15
7.89739
7.08009
5
0
TUGPRE
TUGPO
X
22
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
23
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
DISCUSSION
The main objectives of the study were:
To find out the immediate effect of TENS on spasticity and lower limb
balance in stroke patients.
There was statistical significant improvement in time taken for Time
up and Go test after single session application of TENS. There was no
change in level of spasticity which measured by MAS.[3] Our results
suggest that TENS improves balance and gait in chronic stroke patients.
Proprioceptive sensory damage causes postural control difficulties by
alters one’s body orientation in the environment various types of sensory
stimulation, such as proprioception, induce development of minimum
muscle contraction and activation of the cortex and cerebellum, which
affects balance. This evidence demonstrates that TENS promotes
proprioception and balance.[2]
In previous studies using motor level stimulation threshold,
application of TENS resulted in decreased spasticity in patients with
chronic stroke patients. In this study, TENS was applied to chronic stroke
patients at 100 Hz below threshold on the gastrocnemius to decrease
postural sway. Sensory level TENS was applied on the gastrocnemius was
performed to decrease spasticity. Here, spasticity will not decrease but
TUG score will change by the TENS application because there was only 1
DISCUSSION
time TENS application for immediate effect.[2,5]
Gravelle et al. reported that sensory-level stimulation of a lower
threshold
stimulates
skin
or
proprioceptors
to
increase
skin
or
proprioception to increase standing posture stability. Dickstein et al.
reported that use of TENS led to an increase in somatosensory flow from
the lower extremity.[4]
24
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.

Ng and Hui-Chan applied TENS on acupuncture points and reported
improved gait speed and endurance. Chen applied sensory electrical
LIMITATIONS OF THE STUDY
o The sample size was small, which limits the generalizability of the data.
stimulation on the Achilles tendon and gastrocnemius 6 times per week for
o There was no long-term follow-up.
1 month, and reported significantly increased gait speed in stroke
patients.[1]
The TENS group showed improved gait speed, step length, and

cadence in the affected leg during gait, compared with the Placebo TENS
FURTHER RECOMMENDATIONS
o Study can be done with larger sample size, for longer duration so it will
group. Previous studies used TENS for measurement of balance, but not
gait, or did not report significant improvements in gait; however,
improve spasticity.
correlations were observed between balance and gait function. Further
o Study can be done with other muscle group.
research is needed to develop a more objective design.
o Study can done to know effect of TENS on gait, cadence, step length, stride
length.
26
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
CONCLUSION
On the basis of this study we can say that application of TENS for single
session may not reduce the spasticity but it will improve the balance in
chronic stroke patients.
CONCLUSION
28
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
29
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
SUMMARY
The study is carried out to know immediate effect of TENS on spasticity and lower limb
balance. We took 10 stroke patients who are having lower limb spasticity and who
fulfilled inclusion criteria. Pre and post TUG and MAS were taken. High TENS was
applied for 20minutes.There is no significant difference in MAS but TUG is showing
significant difference that means application of TENS for longer duration may reduce
spasticity and improve balance.
SUMMARY
30
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
31
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
BIBLIOGRAPHY
stroke
1 Bhattacharya S, Prasarsaha S, Basu A, Das K. A 5 year prospective
study of incidence, morbidity and mortality stroke profile on stroke in a
rural community of Eastern India. J Indian Med Assoc 2005; 103 (12):
655_9
2.American Stroke Association. Primary Prevention of Ischemic Stroke: A
Guideline from the American Heart Association/American Stroke
Association Stroke Council. Stroke. 2006;37:1583- 1633
3.PM Dalal, Madhumita Bhattacharjee. Stroke Epidemic in India:
Hypertension-Stroke Control Programme is Urgently Needed. JAPI. Vol
55. October 2007.
Spasticity
5. Mayer NH, Esquenazi A. Muscle overactivity and movement dysfunction
in the upper motoneuron syndrome. Physical Medicine & Rehabilitation
Clinics of North America 2003;14:855–883, vii–viii.
6.Dietz V, Sinkjaer T. Spastic movement disorder: Impaired reflex function
and altered muscle mechanics. Lancet Neurology 2007;6: 725–733.
BIBLIOGRAPHY
Spasticity affect balance(desertation)
7. susan B. o’sullivan Thomas J. Schmitz; physical rehabilitation, F. A.
Davis company,5th addition,2007,stroke 18 ;721-722.
Stretching
32
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
33
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
8. Bovend’Eerdt TJ, Newman M, Barker K, Dawes H, Minelli C, Wade DT.
TUG
The effects of stretching in spasticity: A systematic review. Archives of
13. susan B. o’sullivan Thomas J. Schmitz; physical rehabilitation, F. A.
Physical Medicine & Rehabilitation 2008;89: 1395–1406. 9. Harvey L,
Davis company,6th addition,2007, ;235.
Herbert R, Crosbie J. Does stretching induce lasting increases in joint
ROM? A systematic review. Physiotherapy Research International
2002;7:1–13.
Other therapy
9. Sunnerhagen KS, Olver J, Francisco GE. Assessing and treating
functional impairment in poststroke spasticity. Neurology 2013; 80(3 Suppl
2):S35–44
TENS
10. Yan T, Hui-Chan CW. Transcutaneous electrical stimulation on
acupuncture points improves muscle function in subjects after acute
stroke: A randomized controlled trial. Journal of Rehabilitation Medicine
2009;41:312–316.
11. Junhyuck Park, Dongkwon Seo et all (2014) had shown that TENS
reduces spasticity and may improve the balance in stroke patients.
MAS
12. Gravelle DC, Laughton CA, Dhruv NT et al: Noise-enhanced balance
control in older adults. Neuroreport, 2002; 13(15): 1853–56
13. susan B. o’sullivan Thomas J. Schmitz; physical rehabilitation, F. A.
Davis company,6th addition,2007,s ;172.
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
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IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
ANNEXURE 10.1
Consent form
ુ ન પર ટેન્સ ની તાત્કા઱ીક
- પક્ષઘાત ના દદીઓ માાં જકડાયે઱ા સ્નાયુ અને પગ ના સાંત઱
અસર
:______________________________________________________________________
- ___________
:
/
- ___________________________
________________________________________________________________________
:-_________________________________________________________________
ુ ન પર ટે ન્સ ની તાત્કા઱ીક અસર .
પક્ષઘાત ના દદીઓ માાં જકડાયે઱ા સ્નાયુ અને પગ ના સાંત઱
બ લ
બબ
લ
.
ઓ ખ
બ
ખ
.
એ
.
બ
ANNEXURES
:-
:-
:-
ખ:-
36
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
37
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
Memory
Cognition
Perception
Intelligence
Senasations:
ANNEXURE 10.2
Superficial
Deep
Cortical
DATA COLLECTION FORM
Name:____________________________________ _____________________________
Reflex:
Age:________Gender:__________Height:_______Weight:___________BMI:_________
Biceps jerk:_____________
Address:________________________________________________________________
Ankle jerk:______________
_______________________________________________M:______________________
Knee jerk:______________
Occupation:____________________________________
Strength and flexibility testing of lower limb:
Chief complaints:_________________________________________________________
Muscles
History:
Affected side(Involuntary
muscle grading)
Unaffected side(MMT)
Duration of stroke: ________Side of involvement:_________________________
Type of stroke:__________________ Territory of involvement:______________________
Past medical history:
Diabetes:_____________________
Hypertension:______________________
Gait examination:________________________________________________________________
On Observation:
Balance test: Romberg test:_____________________________
Posture(Attitude of lower limb):_ _______________________________________________
ADL:
____________________________________________________________________________
Eating:_______
On examination:
Grooming:_____
Vitals-HR:______BP:__________Temperature:___________________RR:________________
Toileting:_____
Brief neurological evaluation:
Ambulation:____
Higher center function:
38
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
39
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
ANNEXURE 10.3
MEASUREMENT TOOL
Physical and functional examination:
Out come measure
Pre-training data
Modified Ashworth Scale:
Post-training data
The objective assessment of spasticity was done using this scale.
TUG
The patient was examined lying on a couch in a relaxed position and the
MAS
affected lower limb was moved passively. The resistance encountered by
the therapist to passive movement was then recorded using modified
Remarks:__________________________________________________________________________
ashworth scale, the scale has been mentioned in details in annexure.
Timed Up & Go Test:
It is the quick measure of dynamic balance and mobility. The patient is
seated comfortably in a firm chair with arm and back support. Then patient
is instructed to rise, stand momentarily, and then walk 3 m (10 ft.) toward a
wall at normal walking speed, turn without touching the wall, return to the
chair, turn, and sit down.
Tape is used to mark the walking distance and turning point. Timing with a
stopwatch begins when the patient is instructed with “go” and ends when
the patient return to the start position seated in the chair.
Healthy adults
<10 sec
Older adults
<10 sec (average score)
Frail elder/individual with disability
11-20 sec
Individual with Impaired functional mobility
>30 sec
40
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
41
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.
ANNEXURE 10.4
MASTER CHART
Sr.no
Modified Ashworth
PRE
SCALE
POST
SCALE
TUG test
PRE
SCORE
POST
SCORE
1 1+
1+
55.3
44.2
2 3
3
46.9
41.6
3 1+
1+
42.3
33.6
4 3
3
39.4
32.1
5 1+
1+
33.2
25.6
6 1+
1+
50.51
41.6
7 1+
1+
33.2
25.6
8 1+
1+
40.2
35.1
9 1+
1+
45.2
39.3
1
29.10
23.60
10 1
42
IMMEDIATE EFFECT OF TENS ON SPASTICITY AND BALANCE IN STROKE PATIENTS.