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Objectives: Application of transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS) is a noninvasive intervention that has recently been shown to alleviate dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). This case report aims to explore the role of Acu-TENS in patients diagnosed with COPD during the acute exacerbation., Study Design: The study design was a case report., Setting: The study was conducted in an inpatient setting., Subject: The subject was a 74-year-old man admitted to the hospital due to acute exacerbation of COPD (AECOPD)., Intervention: Treatment consisted of application of TENS on EX-B1 (Dingchuan) for 45 minutes., Outcome Measures: Oxygen saturation, heart rate, and dyspnea score were measured before, immediately after, and 45 minutes after Acu-TENS intervention. Other than the physiologic measures, 10 mL of venous blood was taken from the cubital vein for assessment of β-endorphin level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) level before and immediately postintervention., Results: Postintervention, improved oxygen saturation, and reduction in heart rate and dyspneic sensation were observed accompanied by a raised blood β-endorphin level but the level of white blood cell count, TNF-α, and CRP remain unchanged., Conclusions: Application of 45 minutes Acu-TENS appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive Acu-TENS therapy during acute exacerbation warrants further investigation.

Background Pharmacotherapy is the mainstay of dyspnea management in patients with chronic obstructive pulmonary disease (COPD). Undesirable side effects have led to the application of alternative treatment strategies such as acupuncture. Our previous study showed that transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS), a noninvasive modality, can reduce dyspnea symptoms in patients with COPD, but the underlying mechanism is unknown. Primary Study Objective This study investigated the effect of acu-TENS on forced expiratory volume in one second (FEV1), dyspnea, and Β-endorphin levels in patients with COPD. Design A double-blinded randomized controlled trial Setting: Hospital outpatient clinic Participants Forty-four subjects diagnosed with COPD Intervention Participants were randomly assigned to receive either acu-TENS or placebo-TENS on Dingchuan (EX-B1) for 45 minutes. Outcome Measures FEV1, forced vital capacity (FVC), dyspnea visual analogue score (DVAS), respiratory rate (RR), and blood Β-endorphin levels were measured before and after therapeutic intervention. Results Our findings showed that the increase in FEV1 was 24.2% greater in the acu-TENS group than the placebo group (P < .0001). The decrease in RR and DVAS was also more in the acu-TENS group by 14.2% (P < .0001) and 20.7% (P = .006), respectively. The postintervention increase in Β-endorphin was significantly higher in the acu-TENS than the placebo group (18.3%) (P = .027). Furthermore, the percentage reduction in RR correlated with the increase in Β-endorphin (R = -0.477, P = .033). Conclusion An improvement in FEV1 and dyspnea score at the end of Acu-TENS treatment was associated with a concurrent increase in b-endorphin level in patients with COPD.

Background and Purpose: Impaired walking function and spasticity are common sequelae of stroke. Prior studies have shown that a rehabilitation program combining transcutaneous electrical stimulation (TES) with task-related training (TRT) improves motor function in individuals with stroke. However, it is unclear if this approach is beneficial for individuals with long-standing stroke., Case Description: The subject of this case study was a 61-year-old man who was 7 years poststroke. He exhibited limitations of walking function, impaired strength of the ankle muscles, and severe plantarflexor spasticity., Interventions: For 4 weeks, the patient performed a 5-day/wk home program consisting of 60 minutes of TES (below motor threshold) to the acupoints in the affected lower leg, followed by 60 minutes of TRT. He documented his daily home program activities in a log, and 3 times a week he received a call from the therapist to verify his adherence. The patient also had 8 clinic visits, which focused on instruction to ensure adherence to the (TES + TRT) protocol and progression of the program., Outcomes: After the 4-week program, plantarflexor spasticity decreased and ankle dorsi- and plantarflexor strength improved. More important, there were notable improvements in gait velocity, walking endurance, and functional mobility. These gains were maintained at 4 weeks posttreatment., Discussion: This accessible home program was safe and effective for decreasing impairment and improving function in an individual with long-term, chronic stroke. The gains were maintained 4 weeks posttreatment. Details are provided for developing a home program integrating somatosensory TES and TRT.

Our recent studies showed that one session of transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) improved forced expiratory volume in 1s (FEV(1)) in patients with chronic obstructive pulmonary disease (COPD). This study investigated the effect of 4-week Acu-TENS on physical and psychosocial function in these patients. Twenty-eight patients were randomly allocated to receive 4-weeks of 45-min, 5-days/week, of either Acu-TENS (over Dingchuan), Placebo-TENS (same protocol without electrical output), or Sham-TENS (over the patellae). Variables measured before and after intervention included FEV(1), forced vital capacity (FVC), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire score (SGRQ), beta-endorphin and blood inflammatory marker levels. Only the Acu-TENS group attained significant improvement in FEV(1) (p=0.046), physical activity (p=0.007) and total SGRQ score (p=0.028). The increase in beta-endorphin (p=0.012) correlated positively with the improvement in FEV(1) (r=0.526, p=0.008). To conclude, 4 weeks of Acu-TENS improved the functional capacity of patients with COPD, probably due to the bronchodilation induced by beta-endorphin elevation., (Copyright 2010 Elsevier B.V. All rights reserved.)

Objective: To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke., Design: Randomized, placebo-controlled clinical trial., Setting: Home-based programme., Subjects: One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group., Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment., Outcome Measures: Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended., Results: When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1-57.5%, all P<0.01) and reduction in timed up and go scores (by -14.9 to -23.3%, P<0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2-34.7%, P<0.01) from week 2 onwards., Conclusion: TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

This study examined the effect of transcutaneous electrical nerve stimulation applied over acupoints (Acu-TENS) on forced expiratory volume, in patients with asthma, after exercise. Thirty subjects were randomly assigned to three groups. Group 1 received Acu-TENS over acupuncture points Lieque and Dingchuan for 45 min prior to a symptom-limited treadmill exercise test. Group 2 had Acu-TENS similarly applied prior to and throughout the exercise test. Group 3 mimicked Group 1 but without any electrical output from the device. Forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) were recorded before, immediately after and at 20-min intervals post-exercise for 1h. Immediately after exercise, FEV(1) and FVC rose in Group 2 (p=0.015), but decreased in Group 1 and more so in Group 3. The differences became even more marked at 20, 40 and 60 min. Adjunctive Acu-TENS therapy appears to reduce decline of FEV(1) following exercise training in patients with asthma.

Objective: To investigate whether transcutaneous electrical stimulation, when applied to acupuncture points in patients after acute stroke, decreases spasticity and/or increases muscle strength more effectively than placebo stimulation and standard rehabilitation., Design: Randomized control trial., Subjects: Sixty-two patients aged 70.0 (standard deviation 7.4) years and 9.2 (standard deviation 3.4) days post-stroke., Methods: The patients were randomly assigned to 3 groups receiving transcutaneous electrical stimulation, placebo stimulation, or standard rehabilitation alone. Stimulation was applied to 4 acupuncture points in the affected lower leg for 60 min, 5 days a week for 3 weeks. Plantarflexor spasticity, ankle muscle strength, and functional mobility were measured before treatment, weekly during treatment, and at follow-up at week 8 post-stroke., Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation or placebo stimulation, transcutaneous electrical stimulation to acupuncture points significantly increased the percentage of patients with normal tone, increased ankle dorsiflexor strength, and decreased antagonist co-contraction ratio (p < 0.05). The patients in the transcutaneous electrical stimulation group also tended to walk 2-4 days earlier than the patients in the other 2 groups., Conclusions: Three weeks of transcutaneous electrical stimulation to lower leg acupuncture points, given 5 times a week within 10 days post-stroke, significantly decreased ankle plantarflexor spasticity, and increased dorsiflexor strength concomitant with a decrease in antagonist co-contraction.

Background and Purpose: Previous studies have shown that repeated sensory inputs could enhance brain plasticity and cortical motor output. The purpose of this study was to investigate whether combining electrically induced sensory inputs through transcutaneous electrical nerve stimulation (TENS) with task-related training (TRT) in a home-based program would augment voluntary motor output in chronic stroke survivors better than either treatment alone or no treatment., Methods: Eighty-eight patients with stroke were assigned randomly to receive a home-based program of (1) TENS, (2) TENS+TRT, (3) placebo TENS+TRT, or (4) no treatment (control) 5 days a week for 4 weeks. Outcome measurements included Composite Spasticity Scale, peak torques generated during maximum isometric voluntary contraction of ankle dorsiflexors and plantarflexors, and gait velocity recorded at baseline, after 2 and 4 weeks of treatment, and 4 weeks after treatment ended., Results: When compared with TENS, the combined TENS+TRT group showed significantly greater improvement in ankle dorsiflexion torque at follow-up and in ankle plantarflexion torque at week 2 and follow-up (P<0.01). When compared with placebo+TRT, the TENS+TRT group produced earlier and greater reduction of plantarflexor spasticity and improvement in ankle dorsiflexion torque at week 2 (P<0.01). When compared with all 3 groups, the TENS+TRT group showed significantly greater improvement in gait velocity (P<0.01)., Conclusions: In patients with chronic stroke, 20 sessions of a combined TENS+TRT home-based program decreased plantarflexor spasticity, improved dorsiflexor and plantarflexor strength, and increased gait velocity significantly more than TENS alone, placebo+TRT, or no treatment. Such improvements can even be maintained 4 weeks after treatment ended.

Objective: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on acupuncture points and neck exercise in chronic neck pain patients., Design: A randomized clinical trial., Setting: Hospital-based practice., Subjects: Two hundred and eighteen patients with chronic neck pain., Interventions: Subjects were randomized into three groups, receiving either (1) TENS over the acupuncture points plus infrared irradiation (TENS group); (2) exercise training plus infrared irradiation (exercise group); or (3) infrared irradiation alone (control); twice a week for six weeks., Outcome Measures: The values of verbal numeric pain scale, Northwick Park Neck Pain Questionnaire, and isometric neck muscle strength were assessed before, at the end of the six-week treatment, and at the six-month follow-up., Results: Results demonstrated that after the six-week treatment, significant improvement in the verbal numerical pain scale was found only in the TENS group (0.60+/-2.54, p = 0.027) and the exercise group (1.57+/-2.67, p < 0.001). Though significant reduction in Northwick Park Neck Pain Questionnaire score was found in all three groups, post-hoc tests showed that both the TENS and the exercise group produced better improvement (0.38+/-0.60% and 0.39+/-0.62% respectively) than the control group (0.23+/-0.63%). Significant improvement (p = < 0.001 to 0.03) in neck muscle strength was observed in all three groups, however, the improvement in the control group was not clinically significant and it could not be maintained at the six-month follow-up., Conclusions: After the six-week treatment, patients in the TENS and exercise group had a better and clinically relevant improvement in disability, isometric neck muscle strength, and pain. All the improvements in the intervention groups were maintained at the six-month follow-up.

Objective: To examine if the addition of transcutaneous electrical nerve stimulation (TENS) to exercise training would produce better physical outcomes than TENS or exercise alone in people with knee osteoarthritis., Design: Sixty-two subjects were randomly allocated to four groups., Interventions: Patients received either (1) TENS, (2) placebo stimulation, (3) exercise training, or (4) TENS and exercise training five days a week for four weeks., Main Outcome Measures: The isometric peak torque, spatiotemporal gait parameters and range of knee movement were assessed in treatment session1, session10 and session20 and the four-week follow-up., Results: By session20, the TENS and exercise group demonstrated an average of 26.6% cumulative gain in the knee extensor peak torque for the different knee positions (all p < 0.05). Although the between-group difference was short of being statistically significant, the gain found in the TENS and exercise group was greater than that found in the other three groups. The TENS and exercise group also tended to show greater cumulative increase in stride length (12.6%, p = 0.006), walking cadence (9.3%, p = 0.098) and gait velocity (22.4%, p = 0.034) than the other groups. By session20, it was the only group that produced a significant increase in the range of knee motion during walking (12.0%, p = 0.000). The TENS group and the exercise group both demonstrated some improvements in the above physical outcomes, but negligible change was found in the group receiving placebo stimulation (all p > 0.05)., Conclusion: No significant difference was found among the four treatment protocols, but the addition of TENS to exercise training tended to produce the best overall improvement in physical outcomes in people with knee osteoarthritis.

Artificial neural networks (ANN) have been applied to assist in clinical decision-making and prediction. While we consider possible effective treatments for patients with osteoarthritic knee such as Transcutaneous Electrical Nerve Stimulation (TENS), exercise, and TENS with exercise respectively, we have to select a treatment protocol for patients such that they would gain the best improvements according to their clinical conditions. To facilitate this functionality with the existing patient assessment, we hope to apply the ANN programming techniques to develop a computerized prediction system. A preliminary validation was performed to test the validity of the newly developed prediction protocol on knee rehabilitation. We input the key clinical attributes of 62 patients who have undergone the three above-mentioned knee treatments to the protocol. The expected pain improvement of each patient as predicted by the protocol was obtained. Spearman rank-order correlation was used to identify whether there was a significant correlation between the rankings of the observed and expected pain improvement. We found that the Spearman's rho was 0.424, which is statistically significant at p < 0.001. From this preliminary analysis, we are confident that this newly developed prediction protocol will be useful when deciding which treatment regime best suits a patient.

Objective: This study examined the optimal stimulation duration of transcutaneous electrical nerve stimulation (TENS) for relieving osteoarthritic knee pain and the duration (as measured by half-life) of post-stimulation analgesia., Subjects: Thirty-eight patients received either: (i) 20 minutes (TENS20); (ii) 40 minutes (TENS40); (iii) 60 minutes (TENS60) of TENS; or (iv) 60 minutes of placebo TENS (TENS(PL)) 5 days a week for 2 weeks., Methods: A visual analogue scale recorded the magnitude and pain relief period for up to 10 hours after stimulation., Results: By Day10, a significantly greater cumulative reduction in the visual analogue scale scores was found in the TENS40 (83.40%) and TENS60 (68.37%) groups than in the TENS20 (54.59%) and TENS(PL) (6.14%) groups (p < 0.000), such a group difference was maintained in the 2-week follow-up session (p < 0.000). In terms of the duration of post-stimulation analgesia period, the duration for the TENS40 (256 minutes) and TENS60 (258 minutes) groups was more prolonged than in the other 2 groups (TENS20 = 168 minutes, TENS(PL) = 35 minutes) by Day10 (p < 0.000). However, the TENS40 group produced the longest pain relief period by the follow-up session., Conclusion: 40 minutes is the optimal treatment duration of TENS, in terms of both the magnitude (VAS scores) of pain reduction and the duration of post-stimulation analgesia for knee osetoarthritis.

This study examined whether transcutaneous electrical nerve stimulation or interferential current was more effective in reducing experimentally induced heat pain. Forty-eight young healthy subjects were randomly divided into the following groups: (i) transcutaneous electrical nerve stimulation; (ii) interferential current; and (iii) no stimulation. A multi-function electrical stimulator was used to generate the transcutaneous electrical nerve stimulation or interferential current. A thermal sensory analyser was used to record the heat pain threshold. The stimulation lasted for 30 minutes and the heat pain thresholds were measured before, during and after the stimulation. Transcutaneous electrical nerve stimulation (p = 0.003) and interferential current (p = 0.004) significantly elevated the heat pain threshold, but "no stimulation" did not. The thresholds of the transcutaneous electrical nerve stimulation and interferential current groups were significantly higher than that of the control group 30 minutes into the stimulation (p = 0.017). Both transcutaneous electrical nerve stimulation and interferential current increased the heat pain threshold to a similar extent during stimulation. However, the post-stimulation effect of interferential current lasted longer than that of transcutaneous electrical nerve stimulation.

Objective: To evaluate the cumulative effect of repeated transcutaneous electrical nerve stimulation (TENS) on chronic osteoarthritic (OA) knee pain over a four-week treatment period, comparing it to that of placebo stimulation and exercise training given alone or in combination with TENS., Design: Sixty-two patients, aged 50-75, were stratified according to age, gender and body mass ratio before being randomly assigned to four groups., Interventions: Patients received either (1) 60 minutes of TENS, (2) 60 minutes of placebo stimulation, (3) isometric exercise training, or (4) TENS and exercise (TENS & Ex) five days a week for four weeks., Main Outcome Measures: Visual analogue scale (VAS) was used to measure knee pain intensity before and after each treatment session over a four-week period, and at the four-week follow-up session., Results: Repeated measures ANOVA showed a significant cumulative reduction in the VAS scores across the four treatment sessions (session 1, 10, 20 and the follow-up) in the TENS group (45.9% by session 20, p < 0.001) and the placebo group (43.3% by session 20, p = 0.034). However, linear regression of the daily recordings of the VAS indicated that the slope in the TENS group (slope = -2.415, r = 0.943) was similar to the exercise group (slope = -2.625, r = 0.935), which were steeper than the other two groups. Note that the reduction of OA knee pain was maintained in the TENS group and the TENS & Ex group at the four-week follow-up session, but not in the other two groups., Conclusions: The four treatment protocols did not show significant between-group difference over the study period. It was interesting to note that isometric exercise training of the quadriceps alone also reduced knee pain towards the end of the treatment period.

Objective: To investigate to what extent a single 60-minute session of transcutaneous electrical nerve stimulation (TENS) would modify chronic clinical pain, acute experimental pain, and the flexion reflex evoked in chronic low back pain patients., Study Design: Thirty young subjects with chronic low back pain were randomly allocated to two groups, receiving either TENS or placebo stimulation to the lumbosacral region for 60 minutes. The flexion reflex was elicited by an electrical stimulation applied to the subject's right sole and recorded electromyographically from the biceps femoris and the tibialis anterior muscles., Main Outcome Measures: Subjective sensation of low back pain and the electrically induced pain were measured by two separate visual analog scales, termed VAS(LBP) and VAS(FR), respectively. Data obtained before, during, and 60 minutes after TENS and placebo stimulations were analyzed using repeated measures ANOVA., Results: The VAS(LBP) score was significantly reduced to 63.1% of the prestimulation value after TENS (p<.001), but the reduction was negligible after placebo stimulation (to 96.7%, p = .786). In contrast, no significant change was found in the VASFR score (p = .666) and the flexion reflex area (p = .062) during and after stimulation within each group and between the two groups (p = .133 for VASFR and p = .215 for flexion reflex area)., Conclusions: The same TENS protocol had different degrees of antinociceptive influence on chronic and acute pain in chronic low back pain patients.

Low-intensity repetitive electrical stimulation such as dorsal column and transcutaneous electrical nerve stimulation (TENS) reportedly decreases spasticity and improves voluntary motor control. However, the mechanisms mediating these effects are unclear. Recent findings suggest that spasticity may be characterized more appropriately by a decrease in the stretch reflex threshold than by an increase in gain. Our objectives were: (1) to examine possible changes in stretch reflex excitability following 45 min of TENS, (2) to map out the time course of possible post-stimulation effects via both latency and magnitude (amplitude or area) measurements, and (3) to determine the role of segmental versus non-segmental mechanisms involved in mediating these changes. The effects of 45 min of segmentally and heterosegmentally applied TENS on lower limb reflexes in ten spastic hemiparetic subjects were contrasted with those resulting from placebo stimulation. We found that both segmentally and heterosegmentally applied TENS caused an immediate increase in soleus H reflex latencies that was evident for up to 60 minutes post-stimulation in over 75% of the subjects. Similar increases for up to 60 and 40 minutes post-stimulation was noted for the stretch reflex latencies in 50% and 67% of the subjects respectively for segmental and heterosegmental stimulation. These results suggested that manipulation of segmental and heterosegmental afferents for 45 min may lead to a decrease of the otherwise augmented stretch reflex excitability accompanying hemiparetic spasticity.

The purpose of our study was to determine whether similar or different peripheral afferent fiber(s) is(are) activated by "conventional" transcutaneous electrical nerve stimulation (TENS) applied at low intensity-high frequency, as opposed to "acupuncture-like" TENS administered at high intensity-low frequency. The electrical stimulation was delivered to the median nerve at the wrist of 17 healthy subjects. For conventional TENS, single pulses were applied at an intensity of 3 X T (sensory threshold). Two kinds of acupuncture-like TENS were studied: single pulses at 0.1Hz, and trains of 100Hz pulses at 4Hz, both delivered at an intensity greater than 3 X T. Thirty compound action potentials per type of stimulation were recorded over the median nerve in the cubital fossa and averaged. The results showed that the mean conduction velocities of the afferent fibers excited by conventional TENS, single pulse, and short-train acupuncture-like TENS ranged from 50.3 to 65.4, 50.0 to 63.5, and 41.3 to 54.8m/s, respectively. Thus, conventional and acupuncture-like TENS activated similar fiber types, predominantly in the A alpha beta range. Our findings suggested that the effects of these two types of TENS may be mediated by the activation of similar peripheral afferent fibers.

Our previous studies showed that a single 45 min application of transcutaneous electrical nerve stimulation (TENS) prolonged soleus H and stretch reflex latencies in hemiparetic subjects. In addition, 9 daily 30 min TENS applications enhanced vibratory inhibition of the H reflex and tended to decrease hyperactive stretch reflexes. These findings suggested that longer-term TENS may be effective in reducing hemiparetic spasticity. Our present objectives were 2-fold: to determine whether longer-term repetitive TENS stimulation would lead to a reduction in clinical spasticity in hemiparetic subjects, and whether such a reduction could be associated with a decrease in stretch reflex excitability and an improvement in voluntary motor function. We compared the effects of 15 daily 60 min TENS treatments over a 3 week period, with those of placebo stimulation applied to the common peroneal nerve of the affected leg in similar groups of spastic hemiparetic subjects. Our test battery consisted of 5 measurements which assessed (1) clinical spasticity scores, (2) maximal H reflex to M response ratios, (3) vibratory inhibition of H reflex, (4) stretch reflexes, and (5) maximal voluntary isometric plantarflexion and dorsiflexion, in standing. In contrast to placebo stimulation which produced no significant effects, repeated applications of TENS over time decreased clinical spasticity (P less than 0.05), and increased vibratory inhibition of the soleus H reflex (P = 0.02) after 2 weeks. These changes occurred with a substantial improvement in voluntary dorsiflexing force up to 820%, but not plantarflexing force. They were followed by a reduction in the magnitude of stretch reflexes (P = 0.05) in the spastic ankle plantarflexor, concomitant with a decrease in the EMG co-contraction ratios after a further week of stimulation. Our results thus indicated that repeated applications of TENS can reduce clinical spasticity and improve control of reflex and motor functions in hemiparetic subjects. Furthermore, the underlying mechanisms may be due partly to an enhancement in presynaptic inhibition of the spastic plantarflexor, and partly to a possible "disinhibition" of descending voluntary commands to the paretic dorsiflexor motoneurons.