A Feasibility Study of Adjunct Transcutaneous Electric Stimulation in Post-stroke Incontinence Rehabilitation

The two TENS intervention protocols that will be assessed for safety and feasibility are: Posterior Tibial Nerve TENS – With the appropriate level of assistance and supervision from carers, the participant will assume sitting or lying position with the legs extended. An alcohol swab is used to cleanse the site from excess oil or moisture. The positive electrodes are attached on the medial malleolus and the negative electrodes are attached 10 cm (1 palm-width) above. The TENS machine with a locked pre-set of 10 Hz frequency and 200µs pulse width is turned on and the participant will increase the intensity to a maximum comfortable level below the threshold that causes motor contraction of the toes. The participant ensures that there is no pain or discomfort associated with the therapy. The therapy is delivered for 30 minutes and then the TENS machine is turned off. Parasacral TENS – With the appropriate level of assistance and supervision from carers, the participant will lie down with a towel across the hips. Using the towel to maintain privacy, the pants and undergarments are lowered and the participant assumes a side-lying position with the knees bent. An alcohol swab is used to cleanse the site from excess oil or moisture. The positive electrodes are placed on opposite sides of the second sacral spine and the negative electrodes on the inside of the middle and lower third of the junction between the posterior superior iliac spine and the ischial node. The participant then lies down on supine position and the TENS machine with a locked pre-set of 20 Hz frequency and 150µs pulse width is turned on. The participant will increase the intensity to a maximum comfortable level. The participant ensures that there is no pain or discomfort associated with the therapy. The therapy is delivered for 30 minutes and then the TENS machine is turned off. Participants will be taught the TENS protocol on one day and then given a chance to perform the protocol while being observed by the investigator on the following day. During the observed practice session, the investigator will use an observation checklist to record if the participant required further support and what assistance was needed to perform the TENS protocol. The participant flow through the study is expected to be completed in 4 days. An example of participant flow is as follows: Day 1 - Learn posterior tibial TENS Day 2 - Perform posterior tibial TENS then learn parasacral TENS Day 3 - Perform parasacral TENS then learn sham (shoulder) TENS Day 4 - Perform sham TENS Randomisation will be done to determine the order of TENS protocols that participants are to try. There is no wash-out period involved in this safety and feasibility study.