Učinki transkutane električne živčne stimulacije na spastičnost mišic pri pacientih po možganski kapi – pregled literature : diplomsko delo

Stoklas, Nuša (author), Rugelj, Darja (mentor), Weber, Daša (comentor), Puh, Urška (reviewer)

Uvod: Možganska kap povzroča dolgotrajne in hude posledice za bolnika, pri čemer je največji vpliv mogoče pripisati oslabljeni nevrološki funkciji. Osebe, ki so utrpele možgansko kap, pogosto razvijejo sindrom zgornjega motoričnega nevrona, ki nastane kot posledica okvare v osrednjem živčevju. Spastičnost, ki izhaja iz tega sindroma, povzroča sekundarne zaplete, kot so mišične skrajšave, mišična šibkost in bolečina, ki skupaj prispevajo k večji odvisnosti bolnika od skrbnika in obremenitvi negovalca. Za TENS domnevajo, da modulira spastičnost z različnimi mehanizmi, kot sta zmanjšanje vzdražnosti refleksa na razteg in povečanje presinaptične inhibicije. Vendar pa so dokazi o učinkovitosti terapije TENS za zmanjšanje spastičnost različni. Namen: Namen diplomskega dela je bil na podlagi pregleda literature predstaviti učinke TENS na spastičnost mišic pri pacientih po možganski kapi. Metode dela: Iskanje literature je temeljilo na pregledu člankov v podatkovnih bazah PEDro, PubMed in ScienceDirect v angleškem jeziku. Uporabljene so bile naslednje ključne besede: TENS, spasticity, stroke, cerebrovascular insult. Rezultati: V pregled literature smo vključili šest raziskav, ki so ustrezale vključitvenim kriterijem. V štirih raziskavah so ugotavljali učinke konvencionalnega TENS izvedenega skupaj z nevrofizioterapevtskimi postopki in placebo TENS izvedenega skupaj z nevrofizioterapevtskimi postopki. V eni raziskavi sta avtorja ugotavljala učinke akupunkturnega TENS in placebo TENS skupaj z v funkcijo usmerjeno vadbo, akupunkturnega TENS kot samostojne terapije in ko so bili preiskovanci brez druge terapije. Avtorji zadnje raziskave so ugotavljali razlike v učinkih 30- in 60- minutne uporabe konvencionalnega TENS skupaj z v funkcijo usmerjeno vadbo, ko so preiskovanci slednjo izvajali kot samostojno terapijo. Rezultati pregledanih raziskav so pokazali vecˇje zmanjsˇanje spastičnosti v skupinah, kjer so preiskovanci prejeli TENS skupaj z nevrofizioterapevtskimi postopki v primerjavi s kontrolnimi skupinami, ki TENS niso prejele. V raziskavi, kjer so primerjali rezultate 30- in 60-minutne uporabe TENS so ugotovili, da je slednja učinkovitejša pri zmanjševanju spastičnosti pri osebah v kroničnem obdobju po možganski kapi. Razprava in zaključek: V tem pregledu nobena izmed vključenih raziskav ni dosegla najmanjše klinično pomembne razlike pri oceni učinkov TENS na spastičnost mišic po možganski kapi. Smiselno bi bilo raziskati vpliv TENS na spastičnost zgornjih udov, njegovo učinkovitost v subakutni fazi po možganski kapi, oceniti njegove učinke v daljšem časovnem obdobju in na večjem vzorcu preiskovancev.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, TENS, možganska kap, spastičnost, rehabilitacija
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [N. Stoklas]
• Year: 2020
• Number of pages: 27 str.
• PID: 20.500.12556/RUL-119576
• UDC: 615.8
• COBISS.SI-ID: 27826179
• Publication date in RUL: 10.09.2020

STOKLAS, Nuša, 2020, Učinki transkutane električne živčne stimulacije na spastičnost mišic pri pacientih po možganski kapi – pregled literature : diplomsko delo [online]. Bachelor’s thesis. Ljubljana : N. Stoklas. [Accessed 21 March 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=119576

Secondary language

• Language: English
• Title: Effects of transcutaneous electrical nerve stimulation on spasticity in adults after stroke – literature review : diploma work

Abstract

Introduction: Stroke has long-lasting and profound effects on the patient with the greatest impact attributable to impaired neurologic function. Stroke survivors frequently have an upper motor neuron syndrome that arises as a consequence of lesions in the central nervous system. Spasticity resulting from upper motor neuron syndrome causes secondary complications, such as contractures, muscle weakness, and pain which combined contribute to the patient’s greater dependence on the family members and caregivers. TENS has been hypothesized to modulate spasticity by various mechanisms, such as reducing stretch reflex excitability and increasing presynaptic inhibition. However, the evidence for the effectiveness of TENS on spasticity varies. Purpose: The purpose of this thesis was to determine the effects of TENS on spasticity in patients after stroke based on a review of a given literature. Methods: The literature research was based on peer-reviewed articles using PEDro, PubMed, and ScienceDirect databases in the English language. The following keywords were used: TENS, spasticity, stroke, cerebrovascular insult. Results: After the literature review, we included six studies that met the inclusion criteria. In four studies, the effects of conventional TENS along with neurophysiotherapy interventions and placebo TENS along with neurophysiotherapy interventions were assessed. In one study, the authors assessed the effects of acupuncture TENS and placebo TENS along with task related training, acupuncture TENS as stand-alone therapy and when subjects were without other therapies. The authors of one study investigated the effects of 30- and 60-minute use of conventional TENS along with task related training when subjects administered the latter as a stand-alone therapy. The results of the reviewed studies showed a greater reduction in spasticity in the groups where subjects received TENS along with neurophysiotherapy interventions compared to control groups which did not receive TENS. A study comparing the results of the 30- and 60-minute application of TENS found that the latter was more effective in reducing spasticity in patients in the chronic phase after stroke. Discussion and conclusion: In this review, none of the included studies achieved minimal clinically important difference in the assessment of the effects of TENS on muscle spasticity after stroke. We suggest to investigate the impact of TENS on upper limb spasticity and its effectiveness in the subacute phase after stroke and to evaluate its effects over a longer period of time and on a larger number of subjects.

• Keywords: diploma theses, physiotherapy, TENS, stroke, spasticity, rehabilitation