Transcutaneous Electrical Stimulation of the Abdomen, Ear, and Tibial Nerve Modulates Bladder Contraction in a Rat Detrusor Overactivity Model: A Pilot Study

Rosa L. Coolen,Dennis Frings,Els van Asselt,Jeroen R. Scheepe,Bertil F. M. Blok 대한배뇨장애요실금학회 2023 International Neurourology Journal Vol.27 No.3

Purpose: The global prevalence of overactive bladder (OAB) is estimated at 11.8%. Despite existing treatment options such as sacral neuromodulation, a substantial number of patients remain untreated. One potential alternative is noninvasive transcutaneous electrical stimulation. This form of stimulation does not necessitate the implantation of an electrode, thereby eliminating the need for highly skilled surgeons, expensive implantable devices, or regular hospital visits. We hypothesized that alternative neural pathways can impact bladder contraction. Methods: In this pilot study, we conducted transcutaneous electrical stimulation of the abdominal wall (T6-L1), the ear (vagus nerve), and the ankle (tibial nerve) of 3 anesthetized female Sprague-Dawley rats. Stimulation was administered within a range of 20 Hz to 20 kHz, and its impact on intravesical pressure was measured. We focused on 3 primary outcomes related to intravesical pressure: (1) the pressure change from the onset of a contraction to its peak, (2) the average duration of contraction, and (3) the number of contractions within a specified timeframe. These measurements were taken while the bladder was filled with either saline or acetic acid (serving as a model for OAB). Results: Transcutaneous stimulation of the abdominal wall, ear, and ankle at a frequency of 20 Hz decreased the number of bladder contractions during infusion with acetic acid. As revealed by a comparison of various stimulation frequencies of the tibial nerve during bladder infusion with acetic acid, the duration of contraction was significantly shorter during stimulation at 1 kHz and 3 kHz relative to stimulation at 20 Hz (P=0.025 and P=0.044, respectively). Conclusions: The application of transcutaneous electrical stimulation to the abdominal wall, ear, and tibial nerve could provide less invasive and more cost-effective treatment options for OAB relative to percutaneous tibial nerve stimulation and sacral neuromodulation. A follow-up study involving a larger sample size is recommended.

경피적 미주 신경 자극술의 근골격계 통증에 대한 적용 현황 파악: 한의학적 활용 및 후속 연구를 위한 Scoping Review

배건희 ( Gun Hee Bae ),안정훈 ( Jeong Hoon Ahn ),장동진 ( Dong Jin Jang ),노정희 ( Jeong Hee Noh ),신재권 ( Jae Kwon Shin ),진은석 ( Eun Seok Jin ),염선규 ( Sun Kyu Yeom ),오승주 ( Seung Ju Oh ) 한방재활의학과학회 2024 한방재활의학과학회지 Vol.34 No.1

Objectives This study aimed to understand the general research trends, applicated disease, and methodology of transcutaneous/percutaneous vagus nerve stimulation, contemplating its clinical use in traditional Korean medicine and future research directions. Methods A scoping review was conducted following Arksey and O'Malley Framework Stage and adhering to the PRISMA extension for scoping reviews: checklist and explanation. Papers published until October 30, 2023, were investigated across 10 databases (PubMed, Embase, Scopus, Web of Science, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, KMbase, Science ON, Research Information Sharing Service. The search terms used were ‘Transcutaneous/Percutaneous vagus nerve stimulation’. Results Since 2021, the application of transcutaneous/percutaneous vagus nerve stimulation for musculoskeletal symptoms has been actively researched, predominantly in Asia (37%), Europe (37%), and North America (21%). All 19 papers were part of clinical studies. Chronic pain was noted that most applied disease, it also was found to potentially aid in acute post-surgical pain relief. Major assessment tools include not only simple pain metrics but also pain perception, vagal nerve tension, quality of life, and inflammatory markers. Most procedures were carried out through the ear, which offers a favorable site for therapeutic stimulation without notable side effects. And parameter analysis, frequencies typically ranged around 25 Hz to 30 Hz, while pulse widths were commonly set at 250 μs or 300 μs. Conclusions Transcutaneous/percutaneous vagus nerve stimulation is easily accessible through acupuncture in Korean medicine. Therefore, if future studies establish parameters and clinical significance, it could be utilized as a therapeutic modality. (J Korean Med Rehabil 2024;34(1):65-81)

경피적 전기 신경 자극의 적용 부위에 따른 자율신경계 활성도 변화 비교 및 평가

박승원,최준원,정면규,이강인,김한성,Park, Seung Won,Choi, Jun Won,Jeong, Myeon Gyu,Lee, Kang In,Kim, Han Sung 대한의용생체공학회 2021 의공학회지 Vol.42 No.3

Purpose: The aim of this study is to find the location of acupoints that are effective for increasing parasympathetic nervous system(PNS) activity among acupoints used to relieve symptoms such as dizziness and nausea. Materials and Methods: Twenty healthy adult men participated in this experiment. Transcutaneous electrical nerve stimulation(TENS) was applied to P6(Neiguan), ST36(Zusanli) and BL20(Pishu) for 30 minutes. For 5 minutes before and after stimulation, Electrocardiogram(ECG), Electrodermal activity(EDA), Respiration, and Skin temperature(SKT) were measured using biosignalsplux Professional(biosignalsplux; Portugal). Paired t-test was performed for the results before and after stimulation, and a one-way ANOVA test between stimulations was performed for the rate of change before and after stimulation. Results: When each acupoint was stimulated with TENS, it was found that the PNS was generally activated. In addition, when considering the change in biosignals after stimulation, the participants stimulated with P6 showed the most consistent results. Conclusion: As a result of stimulating each acupoint, it was found that stimulating P6 can effectively increase PNS activity. These results indicate that methods of stimulating P6 may be most effective in alleviating symptoms of motion sickness.

TENS와 SSP가 전류지각역치 및 통증역치에 미치는 효과

윤미정,이완희,Yun, Mi-Jung,Lee, Wan-Hee 대한물리치료학회 2011 대한물리치료학회지 Vol.23 No.2

Purpose: This study was designed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and silver spike point (SSP) therapy on current perception threshold (CPT) and mechanical pain threshold (MPT). Methods: Forty-five healthy adult male and female subjects were studied. Fourteen of them were males and twenty-one were females. Subject were randomly assigned to receive; (1) TENS (80/120 Hz alternating frequency), (2) SSP (3 Hz), or (3) no treatment (control group). Electric stimulation was applied over LI4 and LI11 on acupuncture points of the left forearm for 30 minutes. CPT and MPT were recorded before and after electrical stimulation. The data were analyzed using linear mixed models, with group treated as a between subject factor and time a within-subject factor. Results: At 30 minutes after cessation of electrical stimulation the CPT of C fibers and A${\delta}$fibers was reduced in the TENS group that of C fibers was reduced in the SSP group (p<0.05). After cessation of electrical stimulation, the MPT of C fibers and A${\delta}$fibers increased in the TENS group, and that of A${\delta}$fibers increased in the SSP group (p<0.05). Conclusion: After TENS and SSP stimulation, MPT of C fibers and A${\delta}$fibers were selectively increased. In particular, the TENS group showed increases in both C and A${\delta}$fibers, while the SSP group showed increases only in A${\delta}$fibers.

고빈도 경피신경전기자극의 자극강도에 따른 정상 성인여성 교감신경성 반응의 변화

최유림,이정우,Choi, Yoo-Rim,Lee, Jeong-Woo 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.1

Purpose: The purpose of this study was to investigate the change in sympathetic nervous system responses of healthy adult women with changes in stimulus intensity of high frequency transcutaneous electrical nerve stimulation. Methods: Twenty-four healthy subjects (women) received high frequency electrical stimulation of the forearm. The subjects were randomly assigned to one of two groups; a low intensity stimulation group (n=12) and a high intensity stimulation group (n=12). The electrode attachment was arranged on the forearm of the dominant arm and the electricity stimulus time was 20 minutes. Measured items included skin conductance, pulse rate, skin temperature, and respiration rate. Each was measured at 4 times. Results: Skin conductance and skin temperature showed significant group by time interactions, though there were no significant group and time effects. There were no significant differences according to time, group effect, and a group by time interaction in pulse and respiration rates. Conclusion: High frequency and high intensity electrical stimulation may be helpful for the improvement of sudomotor function through the activation of the sympathetic nervous system. Also, high frequency and low intensity electrical stimulation may be helpful for the reduction of sudomotor function via inhibition of the sympathetic nervous system.

치료적 운동에 기능적 전기자극과 경피신경전기자극 결합이 뇌졸중 환자의 근긴장도 및 뻣뻣함, 균형능력에 미치는 영향

박신준 ( Shin-jun Park ),조균희 ( Kyun-hee Cho ),조용훈 ( Yong-hun Cho ) 대한물리의학회 2017 대한물리의학회지 Vol.12 No.2

PURPOSE: This study aimed to compare the impact of exercise with that of functional electrical stimulation (FES) and transcutaneous electrical nerve stimulation (TENS) on muscle tone, calf muscle stiffness, and balance ability in patients with stroke. METHODS: Thirty patients with stroke were randomly divided into an FES group (n=15) and a TENS group (n=15), and a progressive task-oriented exercise was assigned to them. These exercises were performed non-synchronously from December 5, 2016 to January 31, 2017. Patients underwent TENS and simultaneously exercised for 30 minutes daily, 5 times a week for 4 weeks. To determine the effect of the interventions, muscle tone and stiffness of the medial and lateral region of gastrocnemius muscle were measured using the MyotonPRO instrument and balance was assessed using the Berg Balance Scale. RESULTS: Both groups revealed a significant decrease in muscle tone and stiffness of the medial part of gastrocnemius muscle before and after the interventions (p<.05). Berg Balance Scale scores increased significantly (p< .05). However, none of the other parameters were significantly different (p >.05). CONCLUSION: Our results prove that progressive task-oriented exercise along with FES and TENS decreases muscle tone and stiffness of the gastrocnemius muscle in patients with stroke and improves balance. TENS could serve as a complementary replacement for functional electrical stimulation for in-house training, as TENS poses less risk of muscle fatigue and has lesser contraindications than does functional electrical stimulation.

The effect of single trial transcutaneous electrical nerve stimulation on balance and gait function in elderly people with dementia: a pilot study

( Ju Yeon Jung ),( Jin-hwa Jung ),( Suk-chan Hahm ),( Kyoungsim Jung ),( Sung-jin Kim ),( Hye Rim Suh ),( Hwi-young Cho ) 물리치료재활과학회 2017 Physical therapy rehabilitation science Vol.6 No.2

Objective: Elderly people with dementia experience not only cognitive dysfunction but also motor function deficits, such as balance and gait impairments. Recently, transcutaneous electrical nerve stimulation (TENS) has been used to reduce pain as well as to control muscle spasm, spasticity and motor performance in various types of subjects. The purpose of this study determined the effect of a single trial TENS on balance and gait function in elderly people with dementia. Design: A randomized controlled trial. Methods: Twenty-two subjects with dementia were assigned to the TENS group (n=12) and ten subjects were assigned to the control group (n=10) randomly. Subjects were classified into two groups: the TENS group (n=12) and the placebo-TENS group (n=10). The TENS group had electrical stimulation applied on the calf muscle for 15 minutes, while the placebo-TENS group had not received real electrical stimulation. The timed up and go test (TUG) and functional reach test (FRT) were used to measure the balance function, and the 10 meters walk test (MWT) and 6MWT were used to assess gait ability. All tests were performed before and after intervention under a single-blinded condition. Results: After intervention, there were significant improvements in TUG, FRT, 10MWT, and 6MWT results in the TENS group (p<0.05), while the placebo-TENS group did not show significant changes in all outcome measurements. There were also differences in all tests between the two groups at post-measurements (p<0.05). Conclusions: This study demonstrated that a single trial TENS application on the calf may be used to improve balance and gait function in elderly people with dementia.

과제지향훈련 및 부가적인 TENS 중재가 만성 뇌졸중 환자의 상지 근활성, 운동기능 및 경직에 미치는 효과

조휘영 ( Cho Hwi-young ),정진화 ( Jung Jin-hwa ),정경심 ( Jung Kyoung-sim ),인태성 ( In Tae-sung ) 대구대학교 특수교육재활과학연구소 2016 특수교육재활과학연구 Vol.55 No.3

본 연구는 만성뇌졸중 환자에게 과제지향훈련 및 부가적인 TENS(transcutaneous electrical nerve stimulation) 중재가 상지의 근활성, 운동기능 그리고 경직에 미치는 효과를 규명하기 위하여 실시되었다. 단일맹검 및 사전 무작위 임상시험으로 진행되었으며, 24명의 만성 뇌줄중 환자는 무작위로 실험군(n=12)과 대조군(n=12)로 배정되었다. 실험군은 과제지향훈련을 4주간 주5회, 총 20회 시행하였고, 과제수행 전 30분간 TENS자극을 마비측 팔에 적용받았다. 대조군은 동일한 과제지향훈련을 수행하였고, 속임 TENS자극을 받았다. 근활성은 표면 근전도를 이용하였고, 상지의 운동기능을 측정하기 위하여 Fugl-Meyer 상지 검사를 이용하였다. 또한 경직을 측정하기 위하여 Modified Ashworth Scale(MAS)를 사용하였다. 중재 후 실험군과 대조군 모두에서 근활성이 유의하게 증가하였고, 상지의 운동기능이 유의하게 향상되었다. 또한 경직도 유의한 개선을 보였다. 실험군은 대조군에 비하여 긴노쪽손목폄근과 운동기능 그리고 팔꿉 굽힘근의 경직을 유의하게 개선하였다. 본 연구는 과제지향훈련은 만성 뇌졸중 환자의 근활성 증가, 운동기능개선 그리고 경직 중재에 효과적이며, 부가적인 TENS 중재는 이를 더욱 효과적으로 향상시킴을 증명하였다. This study investigated the efficacy of task-related training (TRT) combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation, motor function and spasticity of upper extremity in chronic stroke patients. This study designed as a pilot randomized clinical trial study. 24 inpatients with chronic stroke were recruited and randomly assigned into two group: the experimental group (n=12) and the control group (n=12). Subjects in the experimental group received high-frequency TENS for 30 minutes on wrist and elbow extensors, while the control group received placebo-TENS stimulation that was not real electrical stimulation. All participants in both groups conducted task-relate training for 30 minutes after TENS application five days a week for four weeks (20 sessions). The primary outcomes of upper limb muscle activation were measured by surface electromyography (EMG), and Fugl-Meyer upper extremity scale (FMUE) was used to assess motor function of upper extremity. Modified ashworth scale (MAS) was used to identify spasticity. The measurements were performed before and after the 4 weeks intervention period. Both groups showed significant improvements in muscle activation, motor function, and spasticity after intervention. Especially, the experimental group shows a significant differences in muscle activation of extensor carpi radialis longus, FMUE, and spasticity on elbow flexor compared to the control group. Our findings indicate that TRT is effective to improve muscle activity, motor function and spasticity in paretic upper limb of chronic stroke patients, and additional TENS application makes this more efficient.

멀미 완화를 위한 비침습적 및 비약리적 방법 비교 및 평가

박승원,최준원,남상훈,최여은,이강인,정면규,신태민,김한성,Park, Seung Won,Choi, Jun Won,Nam, Sanghoon,Choi, Yeo Eun,Lee, Kang In,Jeong, Myeon Gyu,Shin, Tae-Min,Kim, Han Sung 대한의용생체공학회 2021 의공학회지 Vol.42 No.5

Purpose: The purpose of this study is to present a way to alleviate motion sickness(MS) by stimulating acupoint through PEMFs, and to assess the effectiveness of PEMFs against stimulation previously used to stimulate acupoint using biosignal evaluations and surveys. Materials and Methods: Thirteen healthy men participated in the experiment. MS was induced in the participants, and MS relief stimulation was applied for 30 minutes. There were 4 types of MS relief stimulation, and Sham, Reliefband, Transcutaneous electrical nerve stimulation(TENS), and Pulsed electromagnetic fields stimulation(PEMFs) were used. The biosignals were measured during 30 minutes of applying MS relief stimulation, and the symptoms of MS were evaluated through a questionnaire survey. The measured biosignals are Electrocardiogram(ECG), Electrodermal activity(EDA), Respiration, Skin temperature(SKT), and Electrogastrogram(EGG). A one-way ANOVA test was performed for the rate of change by stimulation for MS relief over time. Results: Participants who were stimulated had a sharp decrease in MS symptoms. Biosignals were analyzed to evaluate autonomic nervous system activity, and the parasympathetic nervous system could be activated through stimulation. Conclusion: TENS and PEMFs were more effective in relieving MS symptoms than Reliefband. It is believed that PEMFs will be effective in consideration of the comfort of participants to be applied to actual vehicles, and studies to further verify the effects of PEMFs on MS should be conducted.

Burst형과 고빈도형 경피신경전기자극치료가 실험적 동통역치와 체온에 미치는 영향 비교

김선엽,최흥식,권오윤,Kim, Suhn-Yeop,Choi, Houng-Sik,Kwon, Oh-Yun 대한물리치료과학회 1995 대한물리치료과학회지 Vol.2 No.2

We randomly assigned 61 healthy subjects(male 14, female 47) to compare the experimental pain threshold and skin temperature between high mode TENS and burst mode TENS. In this study, 61 subjects were divided into three groups ; high mode TENS(n=20), burst mode TENS (n=20), and control group(n=21). Experimental pain thresholds and skin temperatures were measured before, immediately after cessation of stimulation, and at 30 minutes post stimulation. Stimulation was applied to the dorsal surface of the forearm(L14, LI10). Pain thresholds were measured by chronaxie meter. Skin temperature were measured by electrical digital thermometer. The results are as follows ; 1. There were no statistical difference in the pain threshold and skin temperature at before TENS stimulation among the three groups(p>0.05). 2. The pain threshold and skin temperature in burst mode TENS group was significantly higher and longer effect than that in high mode TENS group and control group(p<0.01). 3. The pain threshold in burst mode TENS group decreased to prestimulation levels by 30 minutes poststimulation. 4. The skin temperature in burst mode TENS group decreased to prestimulation levels by 20 minutes poststimulation. 5. The skin temperature was significantly difference among three group at immediately after, and at 30 minutes poststimulation and the skin temperature in burst mode TENS group was significantely higher than that in two groups(p<0.001). 6. The increasing rate of pain threshold in high mode TENS group after immediately cassation of stimulation was 24.3%(p<0.001). 7. The increasing rate of pain threshold in burst mode TENS group after immediately cessation of stimulation was 93.5% (p<0.001).