Highlights
- •Sensory stimulation (TENS) improved performance on four tests of motor function in MS.
- •TENS improved self-reported level of walking limitations after the tests.
- •The improvement elicited by the concurrent application of TENS was immediate.
- •TENS was applied with an inexpensive, portable, and easy-to-use device.
Abstract
Background:
Multiple sclerosis (MS) symptoms reported in the first year of the disease include
sensory impairment, fatigue, reduced mobility, and declines in hand function. The
progressive reduction in motor function experienced by persons living with MS is invariably
preceded by changes in sensory processing, which are strongly associated with the
declines in both walking performance and manual dexterity.
Aims:
To assess the influence of concurrent sensory stimulation using augmented transcutaneous
electrical nerve stimulation (aTENS) applied to leg and hand muscles on clinical tests
of motor function in individuals whose mobility was compromised by MS.
Methods:
Thirteen persons with MS (52 ± 8 years; 6 women) and 12 age- and sex-matched healthy
adults (52 ± 9 years) met the inclusion criteria. Participants visited the lab on
two occasions with one week between visits. Each visit involved the participant performing
four tests of motor function and completing two health-related questionnaires (PDDS
and MSWS-12). The tests assessed walking performance (6-min test and 25-ft test),
dynamic balance (chair-rise tes, and manual dexterity (grooved pegboard test). aTENS
was applied through pads attached to the limbs over the tibialis anterior and rectus
femoris muscles of the affected leg, and over the median nerve and the thenar eminence
of the dominant hand. The pads were attached during both visits, but the current was
only applied during the second visit. The stimulation comprised continuous asymmetrical
biphasic pulses (0.2 ms) at a rate of 50 Hz and an intensity that elicited slight
muscle contractions.
Results:
At baseline and during both treatment sessions, the performance on all four tests
of motor function was worse for the MS group than the Control group. The MS group
experienced significant improvements in all outcomes during the aTENS session with
medium-to-large effect sizes. PDDS ratings improved (from 2.8 ± 1.3 to 2.0 ± 1.5;
effect size d = –0.70) and the MSWS–12 scores declined (from 36 ± 11 to 28 ± 12; effect size d = –1.52). The concurrent application of aTENS enabled the MS group to walk further
during the 6-min test (from 397 ± 174 m to 415 ± 172 m; effect size d = 0.81), to complete the 25-ft test in less time (6.7 ± 3.0 s to 6.3 ± 2.9 s; effect
size d = –0.76), to increase the counts in the chair-rise test (from 11.2 ± 3.8 to 13.6 ± 4.8;
effect size d = 1.52), and to perform the grooved pegboard test more quickly (from 110 ± 43 s to
99 ± 37 s; effect size d = –0.98). The only significant effect for the Control group was a significant increase
in the 6-min walk distance (from 725 ± 79 to 740 ± 82 m; effect size d = 0.87).
Conclusions:
Stimulation of sensory fibers with aTENS evoked clinically significant improvements
in four tests of motor function and the self-reported level of walking limitations
in persons who were moderately disabled by MS. Moreover, the improvements in function
elicited by the concurrent application of aTENS were immediate.
Keywords
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Article info
Publication history
Published online: November 05, 2019
Accepted:
November 4,
2019
Received in revised form:
October 26,
2019
Received:
July 16,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
