Transcutaneous Electrical Nerve Stimulation In The Management Of Spasticity In Cerebral Palsy

ABSTRACT BACKGROUND Spastic Cerebral palsy accounts for 70-80% of all types of Cerebral palsy. Spasticity as a major feature limits and restricts patients’ ability to walk, stand, sit, or roll effectively due to excessive muscle contraction interfering with lengthening of the affected muscles. It poses a challenge even though there are well known interventions. Rehabilitation which includes physiotherapy is one of the widely accepted interventions. Physiotherapists in other countries and in Ghana use stretches, splinting and motor control/ training treatment strategies to reduce spasticity. There is growing interest in the use of Transcutaneous Electrical Nerve Stimulation (TENS) in the management of spasticity in Cerebral palsy. TENS is widely used as a pain management tool in Ghana. However, its use in spasticity management has not been explored and this study seeks to investigate the potential of TENS in the management of spasticity in Cerebral palsy, in Ghana. GENERAL AIM: The aim of this study was to evaluate the effectiveness of TENS in the management of calf muscle spasticity among children with Cerebral palsy. METHODOLOGY: This study was a Quasi-Experimental, One group Pre-test – Post-test design. Fifteen (15) children with spastic cerebral palsy who had spasticity in their calf muscles (gastrocnemius and soleus) were recruited for this study. All participants had two different modes of spasticity assessment electrophysiologically using the H reflex responses of calf muscles and clinically using the Modified Ashworth Scale (MAS). A biomechanical assessment was conducted using the Goniometer to assess Range of Motion (ROM) at the ankle joint in ankle dorsiflexion. All participants then received TENS application to the calf muscles for a duration of thirty (30) minutes after which the H-reflex response, MAS and ROM were assessed again respectively, after the intervention. MAS and ROM carried out before and after the intervention were assessed twice for intrarater reliability. Statistical analysis was done using Mann Whitney U test, Spearman’s rank correlation coefficient and Wilcoxon sign rank test. Predictor analysis was also done to evaluate whether application of TENS could lead to low MAS scores. RESULTS: Results from this study showed that there was no significant difference (p>0.05) between left and right H reflex responses, MAS, and ROM scores at the baseline. There was no correlation (left: p = 0.133, right: p = 0.479) between pre-test left and right H reflex Amplitude (HA) scores and the MAS scores. After application of TENS, there was a reduction in spasticity of the calf muscles as measured by the H reflex, MAS, and ROM. However, only the left sided measures were statistically significant (p = 0.011) for the H reflex Amplitude whilst this asymmetry was not seen in MAS (left: p = 0.009, right: p = 0.004) and ROM (left: p = 0.02, right: p = 0.003). CONCLUSION: TENS may be an effective tool for managing spasticity in spastic Cerebral palsy by reducing neuronal excitability. The asymmetry in response to TENS may have been from asymmetrical pathophysiology in the participants of the study