EFFICIENCY OF DENS IN THE EARLY RECOVERY PERIOD OF THE ISCHEMIC STROKE

Drobyshev V. Efficiency of dynamic electroneurostimulation in the early recovery period of the ischemic stroke (randomized placebo controlled study) / V. Drobyshev, V. Poddubnyakova, D. Shashukov , A. Vlasov // 17th ESPRM European Congress of Physical and Rehabilitation Medicine. - Venice. – 2010. – p. 9-11

EFFICIENCY OF DYNAMIC ELECTRONEUROSTIMULATION IN THE EARLY RECOVERY PERIOD OF THE ISCHEMIC STROKE (RANDOMIZED PLACEBO CONTROLLED STUDY)

V. Drobyshev, V. Poddubnyakova
Novosibirsk State Medical University, Novosibirsk, Russia

D. Shashukov,
Municipal Health Care Institution City Hospital No. 2, Novosibirsk, Russia

A.Vlasov
Ural State Medical Academy, Yekaterinburg, Russia

Aim

Motor disorders accompanied by persistent muscle hypertone and peripheral microcirculation disorders are among the most frequently occurring complications of the cerebral stroke.1 The need to look for new rehabilitation methods arises due to the impaired quality of life of patients who have suffered from the ischemic stroke and the limited recovery potential of their support and motor organs.2 The effect of dynamic electroneurostimulation (DENS) includes multi-component neuroreflectory and neurohumoral response activating compensatory and adaptive systems of the body.3 The goal of the study is to evaluate the effect of DENS-optimized comprehensive rehabilitation on the function of the hand in patients with motor disorders in the early recovery period after the ischemic stroke.

Methods

We have examined and treated 112 patients (48 men and 64 women) aged on average 65.3±4.8 who had the ischemic stroke 1-5 months earlier. The following patient inclusion criteria were used: impaired hand function in the form of limited movement in the wrist joint; the following was used as exclusion criteria: malignant course of hypertonia; severe sensor-motor aphasia; daily life disability score on the Rankin Scale (J. Rankin, 1957) over 4 points; Alzheimer disease. Patient evaluation included a standard neurological examination, as well as movement assessment using the muscle strength assessment scale (L. McPeak,1996; M. Weis, 1986) and the Ashfort spasticity scale (D.Wade,1992), pain syndrome evaluation using A.B. Swanson scale (1978), hand function assessment using Frenchay Arm Test (Platz T.,2004), disability degree evaluation using the Rankin Scale and daily living activities assessment using the Barthel scale (D.Wade,1992). The scope of movements was measured with a goniometer and a 4120 model vibrotesiometer was used to measure the sensory sensitivity. Basic treatment included medication therapy, massage of the extremities and kinesitherapy. As a result of random selection the patients were divided into two groups – in the first group that included 60 patients dynamic electroneurostimulation using the DiaDENS-PCM unit was added to basic rehabilitation. Simulation using a placebo device was used in the 2nd group that consisted of 52 patients Neither the physician nor the patients knew about the differences between the units used in each of the groups, therefore the study meets the criteria for a double blind placebo controlled trial. The treatment was delivered using a detachable zone-specific electrode (DENS-applicator); a comfortable power level was selected. On the side of the lesion DENS treatment was delivered on the outer surface of the shoulder, forearm, joint and the area on the posterior side of the neck and around the neck at

77.10 Hz, while the inner surface was treated at 7.7 Hz. The electrode was applied for 5 minutes in each area. On the other side the unit was applied to the inner surface of the shoulder at 10 Hz. On the second day the procedure duration was increased 2 times in comparison with the first one and then was gradually increased until it reached 60 minutes. The treatment course consisted of 16 to 18 procedures.

Results

At the end of the rehabilitation course the spasticity and pain syndrome decrease and movement scope and muscle strength increase was seen in all patients. However test and measurement data indicated that the condition of patients in the first group was better than that in the placebo group (Table I). Thus the muscle strength score in the first group was 1.70 times higher compared to the initial values (P0.05). The same tendency was observed when comparing the spasticity parameters: the score in the first group dropped by 25.6% while in the second group the value decreased only by 10.8%. Tests conducted in the 1st group showed a reduction of the vibration perception threshold by 30.5% which was validly higher than the same data in the placebo group where the perception only grew by 10.1%. In patients whose treatment course included DENS pain syndrome score was 2.4 times lower. While in the placebo group this parameter was reduced 1.2 times (P<0.05). The Frenchay Arm Test score showing hand function recovery grew 2 times compared to the initial value in the 1st group (from 2.1±0.3 points to 4.2±0.2 points, P0.05). Goniometry data showed different growth of active movements in the affected hand in patients who received different kinds of rehabilitation therapy: in the 1st patient group, the scope of movements in the wrist joint in the flexion-extension position grew 1.8 times (from 29.9±1.5 to 52.3±1.4, P0.05). By the end of the rehabilitation treatment course the maximum disability degree measured on the Rankin scale was 26.9% lower in the first group (decreasing from 2.6±0.04 points to 1.9±0.03 points, P0.05).

Table I

Changes of the motor and sensory sphere parameters in cerebral stroke patients following different kinds of treatment.

Upon completion of the rehabilitation course the patients to whom DENS was delivered experienced less difficulties with the skills needed to maintain their daily routine than those in the placebo group: the Barthel scale score grew by 15.1% in the 1st group (from the initial score of 63.2±4.5 points to 72.8±4.3 points, P0.05).

Discussion

We can assume that dynamic electroneurostimulation of the nervous terminal creates afferent input to the cortex structures activating the inhibitory effect on the .-motor neurons and thus reducing spasticity of the interested musculature.1, 2 This leads to an increase of active movements in the joints of the affected extremity which is an important element of the sanogenetic process in post-stroke patients.1

Conclusion

Patients in the early recovery period of the ischemic stroke whose treatment is supplemented by dynamic electroneurostimulation benefit from pain syndrome abatement and hand function improvement which enhances their quality of life.

References

1. Yakhno NN, Vilensky BS. Stroke as a medical and social problem. Russian Med J 2005;12:807-15.
2. Goldblat YuV. Medical and social rehabilitation in Neurology. St. Petersburg. Polytechnica 2006:236.
3. The Universal Register of DENS Therapy II. Chernyshev V.V,Malakhov V.V, Ryavkin A.Y et al. NPPRMP Denas Ekaterinburg.