Gambaran Peningkatan Fungsional Pasien Bell’s Palsy Setelah Pemberian Kombinasi Transcutaneous Electrical Nerve Stimulation (Tens) Dan Exercise : Literature Review

Bell's palsy is an acute weakness or paralysis of the peripheral facial nerve with no known cause. The incidence of Bell's palsy is about 40-70% of all acute peripheral facial nerve palsy, the average prevalence ranges from 10-30% per 100,000 population per year) Data collected from 4 hospitals in Indonesia shows that the frequency of Bell's palsy shows 19.55% of all cases of neuropathy. The incidence of Bell's palsy ranges from 23 cases per 100,000 people annually, most of the cases 85 % cured within 1-2 months which occurs in 8% of cases. The literature Review research is to analyze the description of the functional improvement of Bell's Palsy patients after the combination of Transcutaneous Electrical Nerve Stimulation (TENS) and Exercise. The selection of articles in this study used the PICO mnemonic design. 160 reviewed articles via PubMed and google scholar, article search via PubMed (1), Google Scholar (4). Inclusion and exclusion criteria according to keywords, published in 2010-2021. The results of the analysis of the literature review of 5 articles showed that the male gender was at risk of experiencing Bell's palsy, namely 29 (52.7%) compared to the female sex, which was 26 (47.3%). Functional recovery in Bell's palsy from the mean pre-test and post-test scores, it can be seen that the average pre-test is 5.19 and the average post-test is 3.65. Improved functional recovery in Bell's palsy patients after administering TENS with a combination of Exercise with massage methods.Keywords: Bell’s palsy, TENS and Massage AbstrakBell's palsy adalah kelemahan akut atau kelumpuhan saraf wajah perifer tanpa diketahui penyebabnya. Kejadian Bell's palsy sekitar 40-70% dari seluruh kelumpuhan saraf fasialis perifer akut, prevalensi rata-rata berkisar 10-30% per 100.000 penduduk per tahun) Data yang dikumpulkan dari 4 rumah sakit di Indonesia menunjukkan bahwa frekuensi Bell's palsy menunjukkan 19,55 % dari semua kasus neuropati. Angka kejadian Bell's palsy berkisar 23 kasus per 100.000 orang setiap tahunnya, sebagian besar 85% sembuh dalam waktu 1-2 bulan yang terjadi pada 8% kasus. Penelitian Literatur Review ini untuk menganalisis gambaran peningkatan fungsional pasien Bell's Palsy setelah pemberian kombinasi Transcutaneous Electrical Nerve Stimulation (TENS) dan Latihan. Pemilihan artikel dalam penelitian ini menggunakan desain mnemonic PICO. 160 artikel yang diulas melalui PubMed dan google sarjana, pencarian artikel melalui PubMed (1), Google Cendekia (4). Kriteria inklusi dan eksklusi menurut kata kunci, terbit tahun 2010-2021. Hasil analisis literature review dari 5 artikel menunjukkan bahwa jenis kelamin laki-laki berisiko mengalami Bell’s palsy yaitu 29 (52,7%) dibandingkan dengan jenis kelamin perempuan, yaitu 26 (47,3%). Pemulihan fungsional pada Bell's palsy dari rerata skor pre-test dan post-test, terlihat bahwa rata-rata pre-test adalah 5,19 dan rata-rata post-test adalah 3,65. Peningkatan pemulihan fungsional pada pasien Bell's palsy setelah pemberian TENS dengan kombinasi Latihan dengan metode pijat.Kata kunci: Bell’s palsy, TENS dan pijat

Determination of Current Flow Induced by Transcutaneous Electrical Nerve Stimulation for the Treatment of Migraine: Potential for Optimization

Introduction: Transcutaneous electrical nerve stimulation (TENS) for migraine involves the application of pulsatile stimulation through electrodes placed on the forehead to target the underlying trigeminal nerves. It is a simple, safe modality and has secured clinical approval in several markets including the European Union and the United States. Despite nearing almost 7 years of use (postclinical approval), the exact mechanism of action is not fully known. Guided by the need to stimulate the trigeminal nerves bilaterally, electrode dimensions are simply required to extend enough to cover the underlying nerves. The goal of this study is to examine induced current flow [magnitude and spatial distribution of electric field (EF)] and another driver of stimulation [activating function (AF)] due to TENS therapy for migraine for the first time. We further consider the effect of changing the electrode dimension and shape and propose a design modification to deliver optimal flow.Methods: We developed the first ultra-high-resolution finite element (FE) model of TENS for migraine incorporating the target supratrochlear (ST) and the supraorbital (SO) nerves. We first simulated the clinically approved V-shaped geometry. We then considered three additional designs: extended V-shaped, idealized pill-shaped, and finally an extended V-shaped but with greater contact spacing (extended V-shaped +CS).Results: Our findings revealed that the clinically approved electrode design delivered substantially higher mean current flow to the ST nerve in comparison with the SO nerves (Medial: 53% and Lateral: 194%). Consideration of an extended design (~10 mm longer and ~ 4 mm shorter) and a pill-like design had negligible impact on the induced current flow pattern. The extended V-shaped +CS montage delivered relatively comparable current flow to each of the three target nerves. The EF induced in the ST nerve was 49 and 141% higher in the Medial and Lateral SO nerve, respectively. When considering maximum induced values, the delivery of comparable stimulation was further apparent. Given the existing electrode design's established efficacy, our results imply that preferential targeting of the ST nerve is related to the mechanism of action. Additionally, if comparable targeting of all three nerves continues to hold promise, the extended V-shaped +CS montage presents an optimized configuration to explore in clinical studies.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial

Background and Purpose: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. Methods: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. Results: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P =0.004), Placebo-TENS+TOT (mean difference, 2.63; P <0.001), and Control groups (mean difference, 3.11; P <0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P <0.001) and Uni-TENS+TOT (mean difference, 1.26; P =0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. Conclusions: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03112473.

The effect of transcutaneous electrical nerve stimulation (TENS) on pain control and phenylethanolamine-N-methyltransferase (PNMT) gene expression after cesarean section

Transcutaneous electrical nerve stimulation (TENS) is one of the non-pharmacological methods of pain relief that has been able to reduce pain by 70 to 90% in postoperative pain control. This study aimed to determine the effect of TENS on pain control after cesarean section and its effect on PNMT gene expression. For this purpose, a double-blind randomized clinical trial was performed on 70 Chinese patients with elective cesarean section. Patients were divided into case and control groups. In the case group, TENS and analgesic drugs were used to relieve pain, and in the control group, the only analgesic drug was used. Then the severity of pain, recurrence of pain attacks, the number of analgesic drugs used and the amount of analgesic drug used in the first 24 hours after surgery were evaluated and compared. Blood samples were also taken from patients to evaluate PNMT gene expression. The semi-quantitative RT-PCR was used to study changes in gene expression. The results showed that the group treated with TENS had less pain intensity and less recurrence of pain attacks than the group that received only analgesic medication. Also, the frequency of analgesic drug use and its dose in the TENS group were significantly lower than in the control group. TENS, on the other hand, has been able to greatly reduce the expression of the PNMT gene, which is produced during times of stress. Therefore, it is recommended that TENS be used as a non-invasive and non-pharmacological adjuvant effective in reducing pain after cesarean section.

Acute pain

This chapter discusses the management of acute pain. It begins with an introduction which describes the benefits of acute pain management and the measurement of pain. Analgesic drugs are then described, including paracetamol; non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (including their comparative efficacy). Patient-controlled analgesia (PCA), epidural analgesia, and continuous peripheral nerve blockade are described. Transcutaneous electrical nerve stimulation (TENS) and acupuncture are discussed. The management of the patient with persistent pain and a substance misuse disorder is also discussed. The chapter concludes with a discussion of non-opioid adjuvant analgesics.