# High-Frequency Transcutaneous Electrical Nerve Stimulation in the Management of Pyramidal Tract-Related Spasticity: A Systematic Review

## TL;DR

This systematic review explores how high-frequency transcutaneous electrical nerve stimulation (HF-TENS) can help manage spasticity caused by pyramidal tract injuries.

## Contribution

The paper systematically reviews HF-TENS's effectiveness in managing spasticity related to pyramidal tract lesions, highlighting its potential as a rehabilitation tool.

## Key findings

- HF-TENS reduced spasticity and improved balance in stroke patients with lower limb spasticity.
- HF-TENS also decreased spasticity, pain, and resistance to movement in multiple sclerosis and spinal cord injury patients.
- Application parameters for HF-TENS need standardization for broader clinical use.

## Abstract

It is known that the pyramidal tract is the main pathway that carries signals for voluntary movements. In upper motor neuron lesions, lesions to the pyramidal tract can lead to devastating consequences, one of which is spasticity. Among other rehabilitation techniques, the use of high-frequency transcutaneous electrical nerve stimulation (HF-TENS) could be beneficial in spasticity management. The goal of this systematic review was to summarize previously published information on the use of HF-TENS in the management of pyramidal tract-related spasticity (PTrS). A thorough research of the PubMed, MEDLINE, and Scopus databases was performed. The search identified 340 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. The included studies investigated the effectiveness of HF-TENS on pyramidal tract-related lower limb spasticity. Spasticity was measured through the Modified Ashworth Scale (MAS), Composite Spasticity Scale (CSS), and spinal inhibition reflexes through the H-reflex. Seven records used a 30-minute HF-TENS in stroke human patients with lower limb spasticity. Results showed post-TENS reduction in spasticity and enhancement in balance ability without any significant alteration in Hoffmann's reflex (H-reflex) (p < .05). The last two records performed HF-TENS in multiple sclerosis and spinal cord injury patients with lower limb spasticity. The findings showed that 60-minute HF-TENS alleviated spasticity levels and pain levels as well as decreased resistance to full range of motion (ROM) and ankle clonus (p < .05). HF-TENS seems to be a promising therapeutic tool in managing PTrS. However, there is a need for homogenization of application parameters in order to be applied in rehabilitation centers.