Curr Health Sci J, vol. 46, no. 2, 2020

Combination Therapy for Treatment of Spasticity in Stroke Patients: A Case Study

[Case Report]


(1)Physiotherapy Practice "Dimitrios Athanasiadis", Kavala, Greece,
(2)Department of Physical Medicine and Rehabilitation, Rehabilitation Center EVEXIA, Chalkidiki, Greece,
(3)School of Medicine, University of Patras, Patras, Greece,
(4)Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria,
(5)1st Physical Medicine and Rehabilitation Department, National Rehabilitation Center EKA, Athens, Greece


Background and purpose: Spasticity is a disorder of sensory-motor control that appears as an effect of a lesion in the upper motor neuron and demonstrates sustained or intermittent unintentional muscle activation. Many treatment interventions exist to treat spasticity, and in this study, three of them were combined: vibration, static positioning and transcutaneous nerve stimulation (TENS). Evidence exists regarding the application of each intervention per se, but not in combination. Hence, the aim of the study is to present an innovative treatment approach for spasticity and show the effects it produced on one patient. Methods: The study was a case report. The subject was a 31-year-old male patient who had ischemic stroke a year ago. He demonstrated severe plantar flexion of the left foot due to spasticity. There was a baseline assessment and measurement, one on the end of the intervention (10th week) and a follow-up 8 months after it. Assessment and measurement tools: a dynamic gait analysis on the treadmill by Zebris FDM-T system, electromyography testing (F-wave parameter and stretch reflex activity), the Modified Ashworth Scale (MAS), a standard goniometer, the Motricity index (MI) leg score and a pain dichotomous when stretching and while at rest. Intervention: The intervention lasted 10 weeks, 5 days per week for 30 minutes. The patient was standing on a 30-degree-inclination wedge. The wedge was positioned on a whole-body vibrator set to vibrate with 91Hz of frequency and 1.0mm amplitude. TENS was offered through surface electrodes which were placed on the tibialis anterior and triceps surae muscles, along the sural nerve (impulse frequency: 100Hz, pulse width: 250μs, intensity: 30mA). Results: The range of motion and the MI was increased and the swing-phase of the right foot as well as the standing-phase of the left foot were increased an hour after the intervention. The results were slightly diminished a day and a week after the intervention but a statisti

Combination therapy, TENS, positioning, vibration, spasticity

Yannis Dionyssiotis, 1st Physical Medicine and Rehabilitation Department National Rehabilitation Center EKA-KAT, 13122 Ilion, Athens, Greece, e-mail:

DOI 10.12865/CHSJ.46.02.12 - Download PDF