Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial

J Spinal Cord Med. 2018 Jul;41(4):397-406. doi: 10.1080/10790268.2017.1390930. Epub 2017 Oct 25.


Objective: Spasticity following spinal cord injury (SCI) can impair function and affect quality of life. This study compared the effects of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) on lower limb spasticity in patients with SCI.

Design: Double blind randomized crossover design.

Setting: Neuro-rehabilitation unit, Manipal University, India.

Participants: Ten participants (age: 39 ± 13.6 years, C1-T11, 1-26 months post SCI) with lower limb spasticity were enrolled in this study.

Interventions: Participants were administered electrical stimulation with TENS and FES (duration - 30 minutes) in a cross over manner separated by 24 hours.

Outcome measures: Spasticity was measured using modified Ashworth scale (MAS) [for hip abductors, knee extensors and ankle plantar flexors] and spinal cord assessment tool for spastic reflexes (SCATS). Assessments were performed at baseline, immediately, 1 hour, 4 hours, and 24 hours post intervention.

Results: A between group analysis did not show statistically significant differences between FES and TENS (P > 0.05). In the within group analyses, TENS and FES significantly reduced spasticity up to 4 hours in hip adductors and knee extensors (P < 0.01). SCATS values showed significant reductions at 1 hour (P = 0.01) following TENS and 4 hours following FES (P = 0.01).

Conclusion: A single session of electrical stimulation with FES and TENS appears to have similar anti-spasticity effects that last for 4 hours. The findings of this preliminary study suggest that both TENS and FES have the potential to be used as therapeutic adjuncts to relieve spasticity in the clinic. In addition, FES may have better effects on patients presenting with spastic reflexes.

Keywords: Functional electrical stimulation; Spastic reflexes; Spasticity; Spinal cord injury; Transcutaneous electrical nerve stimulation.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Spasticity / etiology
  • Muscle Spasticity / therapy*
  • Spinal Cord Injuries / complications
  • Spinal Cord Injuries / therapy*
  • Transcutaneous Electric Nerve Stimulation / adverse effects
  • Transcutaneous Electric Nerve Stimulation / methods*