• The Journal of Korean Physical Therapy
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• v.16 no.3
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• pp.97-111
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• 2004

This study, adopting the pretest-post test experimental study, is designed to find out how the functional electrical stimulation makes effect on the balance of a patient with spasticity of the ankle plantarflexor muscle caused by hemiplegic after stroke. The 46 subjects for this study were randomly sampled out of the patients who were hospitalized from September 1, 2003 to November 30, 2003 in H sanitarium in Yangpyung. The patients were with spasticity of the ankle plantarflexor muscle caused by hemiplegic after stroke and able to walk without supporting implements. The purpose of the study is firstly to analyze the change of ROM, FRTof a patient with spasticity of the ankle plantarflexor muscle when the functional electrical stimulation is applied and secondly to find out how the sex, age, height, weight, part of the diagnosis, duration of pain, experience of relapse and getting hurt from a fall of a patient make effect on the change. The experimental group for the study is divided into two to compare the differences of the effect. The exercising treatment only was performed for the conrtol group, and the functional electrical stimulation to the ankle dorsiflexor muscle as well as the exercising treatment was applied to the experimental group. The ROM test was performed to check the range of motion of the ankle with a double armed universal goniometer. The test was done 3 times to take an average. FRT were performed to check the balance. The statistical test was conducted using the SPSS 10.0/PC program by means of the following methods: χ2-test and t-test for testing homogeneity between the groups; paired t-test, independent sample t-test, F-test, and two-way ANOVA for analyzing the changes before and after the treatment. The levels of statistical significance of all the data were maintained at p<.05. According to the test, ROM has more decreased in experimental group than in control group when the functional electrical stimulation was applied only to the experimental group. However, the significant statistic difference was not shown (p=.059). FRT showed remarkable differences in the experimental group compared to the control group, showing the significant statistic difference (p=.000). On the one hand, the change of ROM, FRT related with the sex, age, height, weight, part of the diagnosis, and experience relapse was a meaningless minimum value. The change of ROM related to the duration of pain and the experience of falling down was also meaningless. However, FRT showed significant statistic difference (p<.05). According to the test above, the application of functional electrical stimulation to a patient with spasticity of the ankle dorsiflexor muscle caused by hemiplegic after stroke makes significant effect on the balance of a patient, but the result has nothing with the sex, age, height, weight, part of the diagnosis, duration of pain, experience of relapse and getting hurt from a fall of a patient. However, it is regarded to give contribution to the balance improvement of a patient. Therefore, this study expects to be a valuable clinical material for a patient with spasticity.

• The Journal of the Society of Stroke on Korean Medicine
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• v.12 no.1
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• pp.61-67
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• 2011

Background : Prevalence of spasticity because of stroke are 40% patients after 12 month. Spasticity caused decrease of range of motor, motor function, and active daily living. Electroacupuncture widely used stroke. But it is been studied by systematic review between spasticity and electroacupuncture. This study is aimed to efficacy of electroacupuncture for spasticity because of stroke. Methods : We had used pubmed(www.pubmed.com) and cochrane library(www.thecochranelibrary.com) database. Limits are'human','randomized controlled trial'and'all adult 19+ years'in pubmed. The period was until 15, september, 2011. We used MeSH(Medical Subject Headings terms. The search words were'stroke'[mesh],'muscle spasticity'[mesh and 'electroacupuncture'[mesh]. In cochrane library, we used spasticity and electroacupuncture in cochrane library. We found 19 studies. But only 3 studies were included for inclusion criteria. Results : The appropriate 3 studies were different from subject, acupoint, duration of treatment, endpoint and etc. But these studies were effective for spasticity because of stroke. Conclusion : These studies were not meta analysis because of heterogeneity. But the above results might explain the electroacupuncture were effective for spasticity and further study needed to verify and standard electroacupuncture study for spasticity.

• Physical Therapy Korea
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• v.9 no.2
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• pp.133-144
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• 2002

The purpose of this study was to establish reliability of the Tone Assessment Scale (TAS) translated into Korean in patients with stroke. The TAS consists of resting posture, response to passive movement, and associated reaction to active effort. Fifteen patients (14 males, 1 female) were examined by two raters. Surface electromyography (EMG) data at elbow flexor muscle and joint excursion were collected from 6 patients. To identify the correlation between muscle activity and angular changes of elbow muscle, Pearson product moment correlation was used. The inter-rater and intra-rater reliability of the TAS ranged from very good to good (K/Kw=.61~1.00 for intra-rater and K/Kw=.73~1.00 for intra-rater comparisons) in the sections of resting posture and associated reaction. However, in the section of response to passive movement, the reliability coefficients ranged from very good to fair (Kw=.29~1.00). In the 11th item, correlation between EMG ratio of elbow flexor and angular changes of elbow joint showed statistically strong positive relationship (r=.94, p<.05). These results indicate that the TAS is selectively reliable in the sections of resting posture and associated reaction.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.1
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• pp.1-5
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• 2019

Purpose: In chronic stroke patients, muscle tone and stiffness increase due to ankle spasticity. Electrotherapy may control the spasticity of patients with central nerve system damage via neurophysiological mechanisms. Therefore, this study was conducted to determine the immediate effects of interferential current therapy on gastrocnemius (GCM) muscle. Methods: This study was a one-group pretest-posttest design and 20 stroke patients participated. The experimental group underwent interferential current therapy for GCM for 30 minutes. Muscle tone (MT) and stiffness were assessed using MYOTONE(R) PRO. After 30 minutes of interferential current therapy, MT and stiffness of the affected side and unaffected side by GCM were measured. Results: After interferential current therapy, the medial GCM MT (Hz) was significantly reduced in stroke patients. There was a significant difference in MT between affected GCM muscles and unaffected side medial GCM muscles before intervention, but there was no significant difference after interferential current therapy. Conclusion: This study demonstrated that interferential current therapy had a positive effect, producing an immediate decrease in the medial GCM muscles tone of stroke patients. However, this study employed a one-group pretest-posttest design. Future studies will show differences in muscle tone compared to a control group or other electrical stimulation treatments.

• Physical Therapy Korea
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• v.4 no.1
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• pp.70-77
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• 1997

An A-B-A-C single subject research design was used to assess the effectiveness of transcutaneous electrical nerve stimulation(TENS) and inhibitive techniques on spasticity in a 10-year-old girl with cerebral palsy. Stimulation electrodes were placed over the sural nerve of the right leg. The standard method of cutaneous stimulation, TENS with impulse frequency of 100 Hz, was applied. Inhibitive techniques including stretch, antagonist contraction, and weight bearing were used. The tonus of the leg muscle was measured by means of a surface-EMG biofeedback unit. Visual analysis of data indicate that the child showed clinically significant reduction of spasticity in passive ankle movement following 30 minutes of TENS and inhibitive techniques application, respectively. The effect of TENS on spasticity inhibition was similar to that of inhibitive techniques. This result suggests that for this child with cerebral palsy, the application of TENS to the sural nerve may induce short-term post-stimulation inhibitory effects on the spasticity of cerebral palsy. Replication of this study with a more complex single-subject design involving more subjects is recommended to confirm this result.

• Physical Therapy Rehabilitation Science
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• v.11 no.2
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• pp.113-118
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• 2022

Objective: This study was conducted to investigate the effect of heel-raise-lower exercise on spasticity, strength, and gait speed after the application of tapingin patients with stroke. Design: Randomized controlled study Methods: The participants were randomly divided into the heel raise-lower exercise+taping (HREx+T) group and the heel raise-lower exercise (HREx) group, with 20 participants assigned to each group. Both groups performed heel lifting exercise 100 times a day 5 times a week for 6 weeks. HREx+T group additionally applied taping to the plantar flexor muscles. 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 measure plantar flexor strength and gait speed, respectively. Results: Spasticity was significantly more improved in the HREx+T group than in the HREx group (p<0.05). Similarly, plantar flexor strength was significantly more improved in the HREx+T group than in the HREx group (p<0.05). Moreover, participants assigned to the HREx+T group showed significantly greater improvement in gait speed than those in the HREx group(p<0.05). Conclusions: Thus, heel-raise-lower training combined with taping may be used to improve the spasticity, muscle strength and gait speed in stroke patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.1
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• pp.11-28
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• 2005

Spasticity has been defined as "a motor disorder characterized by a velocity-dependent increased in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one components of the upper motorneuron syndrome". Spasticity is one of the common symptoms of stroke patients and frequently interferes with the motor functions such as gait, posture and activities of daily living. Therefore, its management is becoming a major issue in physical therapy. The purpose of this study was to determined the effects of reciprocal inhibition by isometric contraction of pre-tibia muscle on spasticity in hemiplegic patients through Hoffmann reflex. The subjects were consisted 45 patients who had hemiplegia due to stroke. All subjects randomly assigned to 3 group: manual reciprocal inhibition program group(manual group), neuromuscular electrical stimulation group(NMES group) and control group. The manual group received voluntary isometric contraction of pre-tibia muscle. The NMES group received neuromuscular electrical stimulation on tibialis anterior. The control group was not received any therapeutic intervention. Before and after experiments, Hoffmann reflex, M-wave and Modified Ashworth scale was measure in all patients. The data of 30 patients who complete experimental course were statistically analysed. Modified Ashworth scale were significantly decreased after experiment in manual group(p<.01). The Hmax/Mmax ratios were significantly decreased after experiment in manual group(p<.o1). There were no statistical difference between pre-test and post-test with modified Ashworth scale in NMES group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in NMES group(p>.01). There were no statistical difference between pre-test and post-test with modified Ashworth scale in control group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in control group(p>.01). The present results revealed that reciprocal inhibition which produced by voluntary isometric contraction of pre-tibia muscle can be reduce spasticity of gastrocnemius. Therefore, reciprocal inhibition is useful to improve functional activities in hemiplegic patient. Further study should be done to analyse the effects of intervention duration of reciprocal inhibition, appropriate muscle contraction, optimal time to apply the reciprocal inhibition in more long period.

• Journal of Acupuncture Research
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• v.17 no.2
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• pp.209-220
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• 2000

Spasticity, an abnormal increase in resting muscle tone, is one of the most common symptoms of stroke, and its management is becoming a major issue in rehabilitation. The aims of this study are to determine the effects of electroacupuncture(EA), TENS and neuromuscular electric stimulation(NMES) on spasticity, as well as the possibility of tissue comliance method as a spasticity scale. 45 stroke patients participated in a study of the effects on hemiplegic spasticity of EA, TENS and NMES. Spasticity was measured by modified Ashworth scale on the upper extremity and tissue compliance measurement, penetration mm/kg, on Susamni(LI10) area at just before and after stimulation, and 30 minutes, 1 hour, 2 hours and 24 hours after stimulation. The acupuncture points were applied to Kokchi(LI11), Susamni(LI10), Hapkok(LI4) and Oegwan(TE5) of the affected limb. The electrodes were placed unilaterally on LI11 to LI10 and TE5 to LI4. EA with biphasic wave, 60Hz, 0.4 msec pulse duration and low intensity was applied continuously for 20 minutes. TENS with high frequency, low intensity was applied. NMES was applied with spasticity program for 20 minutes. Each electric stimulation was done on extensor muscles group of forearm for 20 minutes. EA and NMES groups were found to produce a statistically significant decrease(p〈0.05) of spasticity and these effects lasted up to 30 minutes after stimulation. There was no definite correlation between the modified Ashworth scale and tissue compliance measurement. But tissure compliance method was found to be possible as a quantitative measurement on spasticity. There was no significant correlation between the effects of EA and NMES and the characteristics of patient, but significant correlation between the effects of EA and NMES and the modified Ashworth scale.

• The Journal of Internal Korean Medicine
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• v.35 no.1
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• pp.1-11
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• 2014

Objectives : To investigate the effects of Sa-am acupuncture on muscle architecture and elastic properties of the spastic elbow flexor and to evaluate the correlation between clinical findings and parameters of real-time sonoelastography (RTS) in patients with chronic post-stroke hemiparesis. Materials and Methods : Seven patients (five males, two females) with chronic post-stroke hemiparesis were included. Sa-am acupuncture of Ganseunggyeok (肝勝格: LU8 LR4 補, HT8 LR2 瀉) was applied to the unaffected side 3 times a week for 4 weeks. During each acupuncture treatment period, patients were requested to exercise their affected arm, and spasticity and functional recovery outcomes of the affected arm were evaluated before and after Sa-am acupuncture treatment. Clinical outcomes were assessed using motricity index (MI), modified Ashworth scale (MAS), Fugl-Meyer assessment scale (FMA) and modified Barthel index (MBI) for elbow flexor spasticity. RTS images indicate the relative hardness of the examined muscles ranged from red (hard) to purple (soft) for color-scale, and from black (hard) to white (soft) for hue scale. Color and hue histograms of the biceps brachii and brachialis were analyzed using Image J software, and median red, blue, and hue pixel intensity were obtained. Results : MI and FMA score significantly increased and MAS score significantly decreased (p<0.05). F-wave maximal amplitude of affected abductor pollicis brevis significantly decreased (p<0.05). Muscle thickness of affected brachialis significantly increased (p<0.05). Red and green pixel intensity of affected brachialis significantly decreased (p<0.05). Conclusions : Our study revealed that Sa-am acupuncture is effective as a useful and safe treatment for spasticity in chronic post-stroke hemiparesis.

• Journal of the Korean Society for Precision Engineering
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• v.26 no.7
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• pp.142-149
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• 2009

The aim of this study was to identify both the mechanical and reflex properties associated with spasticity in hemiplegic patients. Ten hemiplegic patients were included in this study. Multiple pendulum tests were executed for each subject, and knee joint angle and EMG of Rectus Femoris muscle were measured. The neuromusculoskeletal system model was developed from generally accepted mechanism and identified through minimization of the error in the model-predicted pendulum trajectories. The identification was successful in terms of small error in simulated kinematics and high sensitivity and precision of simulated torque against EMG activity. The reflex threshold showed significant difference between different clinical scores (p<0.01) and significant negative correlation (r=-0.93) with the EMG duration. It is expected that the suggested method may help in understanding mechanisms underlying spasticity.