Abstract
Objective: This study was conducted to investigate the effect of the heel-raise-lower exercise on spasticity, strength, and gait speed after the application of 30 min of transcutaneous electrical nerve stimulation (TENS) in patients with stroke. Methods: The participants were randomly divided into the TENS group and the placebo group, with 20 participants assigned to each group. In the TENS group, heel-raise-lower exercise was performed after applying TENS for six weeks. The placebo group was trained in the same manner for the same amount of time but without electrical stimulation. The spasticity of the ankle plantar flexors was measured using the composite spasticity score. A handheld dynamometer and a 10-m walk test were used to evaluate muscle strength and gait speed, respectively. Results: Spasticity was significantly more improved in the TENS group (mean change −2.0 ± 1.1) than in the placebo group (mean change −0.4 ± 0.9) (p < 0.05). Similarly, muscle strength was significantly more improved in the TENS group (6.4 ± 3.3 kg) than in the placebo group (4.5 ± 1.6 kg) (p < 0.05). Moreover, participants assigned to the TENS group showed a significant greater improvement in gait speed than those in the placebo group (mean change −5.3 ± 1.4 s vs. −2.7 ± 1.2 s). Conclusions: These findings show the benefits of heel-raise-lower exercise after TENS for functional recovery in patients with stroke.
Highlights
Patients with stroke experience gait disorders due to various causes, including sensory impairment and muscle weakness, spasticity, etc., and the primary goal of rehabilitation is to regain independent walking [1,2,3]
Another study reported a significant increase in plantar flexor power, walking speed, and cadence in stroke patients who performed a heel-raise exercise using a block to achieve dorsiflexion of the forefoot compared with those who performed the same exercise on a flat surface
Changes in Spasticity The Transcutaneous electrical nerve stimulation (TENS) group showed a greater degree of improvement in spasticity than the placebo group (p < 0.05) (Table 2)
Summary
Patients with stroke experience gait disorders due to various causes, including sensory impairment and muscle weakness, spasticity, etc., and the primary goal of rehabilitation is to regain independent walking [1,2,3]. The strength of the ankle plantar flexors on the paretic side is related to the gait speed of patients with stroke [3,10,11]. Fujiwara et al [14] reported a significant increase in the strength and thickness of the plantar flexors and a decrease in postural sway in elderly subjects after eight weeks of heel-raise exercise. Another study reported a significant increase in plantar flexor power, walking speed, and cadence in stroke patients who performed a heel-raise exercise using a block to achieve dorsiflexion of the forefoot compared with those who performed the same exercise on a flat surface. Plantar flexor spasticity must be controlled so that the muscles can sufficiently stretch and undergo eccentric contractions
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