The Effects of Concomitant Application of TENS and NMES on Chronic Stroke Patients: A Prospective Randomized Controlled Study

Background: The aim of our study was to compare the effects of TENS, NMES, and their combined application on posture, functional independence, and spasticity in patients with post-stroke hemiparesis. Methods: Sixty patients (twenty-six female and thirty-four male), with a mean age of 61.1 years (range, 27 – 81 years) were included in our study. Patients were randomly assigned to one of four treatment groups: TENS, NMES, TENS+NMES, and isolated exercise program. The patients' posture, functional independence, and ankle plantar flexor spasticity were evaluated after 1 month of treatment and at the 4-month follow-up. Results: Concomitant application of TENS and NMES was more successful in improving posture, functional independence and reducing spasticity at 1 and 4 months follow-up than either application alone. The application of TENS or NMES together with the exercise program provided better results in terms of posture and functional independence at the 1st month. However, it did not achieve a significant difference compared to the exercise program at the 4th month. An exercise program alone was insufficient for reducing spasticity of the ankle plantar flexors. While an additional physical therapy modality (TENS or NMES) was effective in reducing spasticity in the early period, this effect disappeared at the 4th month follow-up and similar results were achieved with an isolated exercise program. Conclusion: Although TENS or NMES combined with exercise programs achieves successful results immediately after the treatment, it is insufficient after a few months in chronic stroke patients. In concomitant application of TENS and NMES, better results are achieved both after treatment and in a few months of follow-up. Therefore, TENS and NMES should be applied concomitantly.