Effectiveness of Heel-Raise-Lower Exercise after Transcutaneous Electrical Nerve Stimulation in Patients with Stroke: A Randomized Controlled Study

Abstract

Objective: This study was conducted to investigate the effect of the heel-raise-lower exercise on spasticity, strength, and gait speed after the application of 30 min of transcutaneous electrical nerve stimulation (TENS) in patients with stroke. Methods: The participants were randomly divided into the TENS group and the placebo group, with 20 participants assigned to each group. In the TENS group, heel-raise-lower exercise was performed after applying TENS for six weeks. The placebo group was trained in the same manner for the same amount of time but without electrical stimulation. The spasticity of the ankle plantar flexors was measured using the composite spasticity score. A handheld dynamometer and a 10-m walk test were used to evaluate muscle strength and gait speed, respectively. Results: Spasticity was significantly more improved in the TENS group (mean change -2.0 +/- 1.1) than in the placebo group (mean change -0.4 +/- 0.9) (p < 0.05). Similarly, muscle strength was significantly more improved in the TENS group (6.4 +/- 3.3 kg) than in the placebo group (4.5 +/- 1.6 kg) (p < 0.05). Moreover, participants assigned to the TENS group showed a significant greater improvement in gait speed than those in the placebo group (mean change -5.3 +/- 1.4 s vs. -2.7 +/- 1.2 s). Conclusions: These findings show the benefits of heel-raise-lower exercise after TENS for functional recovery in patients with stroke.