Tens is it effective in reducing spasticity in multiple sclerosis
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TENS: Is it effective in reducing spasticity in Multiple Sclerosis? . The Ayrshire Multiple Sclerosis Service. Caledonian University, Glasgow. The Multiple Sclerosis Society. Linda Miller Senior Physiotherapist. TENS.

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Tens is it effective in reducing spasticity in multiple sclerosis l.jpg
TENS: Is it effective in reducing spasticity in Multiple Sclerosis?

The Ayrshire Multiple Sclerosis Service. Caledonian University, Glasgow.

The Multiple Sclerosis Society.

Linda Miller Senior Physiotherapist


Slide2 l.jpg
TENS Sclerosis?

  • Transcutaneuos Electrical Nerve Stimulation: Electrical stimulation of low intensity, high frequency with short pulse widths selectively stimulates large diameter (Group II), mechanosensative surface nerve endings.

  • Mechanisms of action: segmental inhibition, release of endogenous opiods, physiological blocking, placebo.


Spasticity tens l.jpg
Spasticity & TENS Sclerosis?

  • Evidence of change in neurophysiological measures post TENS.

  • Reduction in spasticity in stroke & SCI.

  • Limited research in MS.

  • Clinical experience of reduction in spasm.


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Aims of the study Sclerosis?

  • To determine whether TENS was effective in reducing spasticity in Multiple Sclerosis.

  • To determine whether TENS was effective for muscle spasm or pain associated with spasticity.

  • To determine whether application time has an impact on the overall effectiveness of TENS.

  • To establish protocols for future studies


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Study Design Sclerosis?

  • 32 patients from Ayrshire MS service.

  • Repeated crossover design. Subjects randomly assigned 2 groups

  • All subjects used TENS for 2 weeks, 60 min per day and for 2 weeks, 8 hrs per day.

  • Single blind (assessor).

  • TENS 100Hz, 0.125ms, continuous pulse over quadriceps muscle.


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Study Design Sclerosis?


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Outcome Measures Sclerosis?

  • Demographic data

  • Global Spasticity Score(Ash+PTR+ Clonus)

  • Modified Penne Spasm Score

  • Visual Analogue Score

  • Compliance diary

  • Questionnaire


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Data Analysis Sclerosis?

  • A 2 sample T - test was used to check the comparability of the demographic & baseline variables of the 2 groups (Mann-Whitney:not normal).

  • A 3-factor ANOVA(GSS) used to establish that there was no difference between 2 groups.

  • A paired Wilcoxin was performed on the before & after data (GSS,PSS,VAS) from both groups for 60 min & 8 hrs.


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Results 1 Sclerosis?

  • No significant difference between the 2 groups for baseline & demographic data

  • No sig diff between the groups (p=0.765)

  • No sig diff in the GSS following TENS (60 min & 8hrs) and in the PSS & VAS following TENS (60 min)


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Results 2: However! Sclerosis?

  • Mean scores reduced post TENS, with scores reducing following 8hrs >60min TENS.

  • Significant reduction in PSS & VAS following TENS (8hrs) p0.05.

  • Wide variability in all scores : more subjects with scores reduced after 8hrs:60min TENS.



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Questionnaire Results Sclerosis?

  • The majority of subjects felt TENS had reduced symptoms (88% for spasm).

  • 72% reported benefits lasting lasting 2-3 days after stopping TENS.

  • 81% indicated they would continue to use TENS. Most preferred to use <8 hrs

  • Long term follow up TENS(9 - 21mths) 56% still using.


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Conclusion Sclerosis?

  • No statistically significant reductions in spasticity although the majority of subjects demonstrated clinically significant reductions.

  • TENS is most effective for spasm & pain associated with spasticity.

  • TENS is more effective when used for longer applications.

  • TENS is well tolerated and easy to use.


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Future Implications Sclerosis? The potential for symptom reduction, combined with reduced medication-related complications and costs makes TENS a treatment worth considering in the overall management of people with mild to moderate spasticity in Multiple Sclerosis.


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