Effects of transcutaneous electric neuro stimulation and senzory electric stimulation on upper limb motor abilities in patients after stroke

Uvod: Pacienti se po možganski kapi soočajo s funkcionalnimi težavami zgornjega uda in rok, kot so zmanjšana zmožnost seganja, pobiranja, držanja in rokovanja s predmeti, kar ima za posledico zmanjšano sposobnost opravljanja dejavnosti vsakodnevnega življenja. Rehabilitacija spodbuja okrevanje s postopki, ki vplivajo na plastičnost možganov, med drugim tudi TENS in tako imenovana senzorična električna stimulacija. Ločevanje obeh metod je vprašljivo, saj tudi TENS stimulira senzorična živčna vlakna. Namen: Namen diplomskega dela je bil pregledati izsledke raziskav o učinkih TENS in senzorične električne stimulacije, kot so ju poimenovali avtorji, na gibalne sposobnosti zgornjega uda pri pacientih po možganski kapi. Metode dela: Raziskovalne članke smo iskali v podatkovnih zbirkah PubMed PEDro in CINAHL. Rezultati: Na podlagi kriterijev za vključitev, smo v pregled vključili devet raziskav, v petih so proučevali TENS in v štirih tako imenovano senzorično električno stimulacijo. Objavljene so bile od leta 1998 do 2018. Sodelovalo je od najmanj 28 do največ 112 preiskovancev. Ocene po lestvici PEDro so bile od 3 do 7. V dveh raziskavah so ugotovili, da TENS klinično pomembno izboljša gibalno funkcijo in v eni raziskavi, da izboljša mišično jakost in občutek za gibanje sklepa. V dveh raziskavah so ugotovili, da senzorična električna stimulacija klinično pomembno izboljša funkcijo in gibalno funkcijo, v eni raziskavi pa so ugotovili, da izboljša moč in zaznavanje. Razprava in zaključek: Po pregledu literature smo ugotovili, da so v treh raziskavah, kjer so izvajali TENS, opazili izboljšanje gibalnih sposobnosti zgornjega uda, tudi v kroničnem obdobju po kapi, pomembno pa je vplival tudi na mišično aktivacijo. Pri pacientih v akutnem obdobju po kapi, senzorična električna stimulacija izboljša zaznavanje prostora, jakost prijema, funkcijo in hitrost izvajanja testov, pri pacientih v kroničnem obdobju po kapi pa vpliva na gibalno funkcijo in čas izvedbe testov. Glede na raznolikost raziskav glede parametrov, časovnega obdobja stimulacije, postavitve elektrod in obdobja po možganski kapi, je potrebno izvesti več randomiziranih kontroliranih raziskav s TENS in senzorično električno stimulacijo.Introduction: Patients after stroke have functional problems of the upper limb, including decreased ability of reaching, picking up, holding, and handling objects, which leads to decreased ability to perform activities of daily living and cause decreased quality of life. Rehabilitation includes procedures that stimulate brain plasticity, including TENS and so called sensory electrical stimulation. Distinguishing between both methods is questionable, because TENS stimulates the sensory nerve fibres. Purpose: The purpose was to review studies of the effects of TENS and sensory electrical stimulation, as have been named by the authors, on improving movement of the upper limb in patients after stroke. Methods: Research articles were searched in the databases PubMed, PEDro, and CINAHL. Results: According to inclusion criteria, nine studies were included: five studied TENS, and four the sensory electrical stimulation. The studies were published between 1998 and 2019 and included from 28 to 112 participants. PEDro scores were between 3 and 7. TENS improved movement function (clinically significantly) in two studes and muscle strength and kinaesthesia in one study. The sensory electrical stimulation improved motor abilities (clinically significantly) in two studies and muscle strength and limb perception in one study. Discussion and conclusion: TENS was most effective in patients with low degree of hemiparesis, causing improvement of muscle activation and function. The sensory electrical stimulation improved perception of upper limb, grip strength, function of upper limb and it also improved time performance of test. Because of several differences between the reviewed studies, including parameters of electrical stimulation, duration of stimulation, electrode positioning, and time after stroke, further randomised controlled studies are required with TENS and/or sensory electrical stimulation