4.5 Article

Relief of post-stroke spasticity with acute vibrotactile stimulation: controlled crossover study of muscle and skin stimulus methods

Journal

FRONTIERS IN HUMAN NEUROSCIENCE
Volume 17, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fnhum.2023.1206027

Keywords

muscle spasticity; vibration; stimulation; stroke; stroke rehabilitation

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This study investigates the effectiveness of different approaches of vibrotactile stimulation in reducing spastic hypertonia in post-stroke patients. The results show that cutaneous stimulation of the hand is the most effective method in reducing spastic hypertonia, compared to muscle stimulation and antagonist muscle stimulation.
BackgroundPrior work suggests that vibratory stimulation can reduce spasticity and hypertonia. It is unknown which of three predominant approaches (stimulation of the spastic muscle, antagonist muscle, or cutaneous regions) most reduces these symptoms.ObjectiveDetermine which vibrotactile stimulation approach is most effective at reducing spastic hypertonia among post-stroke patients.MethodsSham-controlled crossover study with random assignment of condition order in fourteen patients with post-stroke hand spasticity. All patients were studied in four conditions over four visits: three stimulation conditions and a sham control. The primary outcome measure was the Modified Ashworth Scale, and the secondary outcome measure was the Modified Tardieu Scale measured manually and using 3D motion capture. For each condition, measures of spastic hypertonia were taken at four time points: baseline, during stimulation, after stimulation was removed, and after a gripping exercise.ResultsA clinically meaningful difference in spastic hypertonia was found during and after cutaneous stimulation of the hand. Modified Ashworth and Modified Tardieu scores were reduced by a median of 1.1 (SD = 0.84, p = 0.001) and 0.75 (SD = 0.65, p = 0.003), respectively, during cutaneous stimulation, and by 1.25 (SD = 0.94, p = 0.001) and 0.71 (SD = 0.67, p = 0.003), respectively, at 15 min after cutaneous stimulation. Symptom reductions with spastic muscle stimulation and antagonist muscle stimulation were non-zero but not significant. There was no change with sham stimulation.ConclusionsCutaneous vibrotactile stimulation of the hand provides significant reductions in spastic hypertonia, compared to muscle stimulation.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT03814889.

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