"Doing the RIGHT thing at the RIGHT time, in the RIGHT order is crucial to achieving the best possible results." - Karen Pape.
The range of neurological disorders currently affecting the lives of children in Australia is varied and vast. The presentation and prognosis differs significantly between diverse disorders and individuals but each condition affects the brain, spinal cord, nerves and/or muscles to some extent. Children with neurological disorders are often treated by a team of health care professionals utilizing a variety of methods. TES is one treatment option that has recently been researched in a number of different disorders. Perhaps one of the greatest attractions in the use of TES for children is the ability to deliver it at night, while the child sleeps. This provides a less invasive option for children who are often already experiencing a gruelling treatment plan and leaves their waking hours for playing, learning, socialising and to just be kids!
So now we will introduce you to some of the most common neurological disorders that TES has been used as a treatment option.
Cerebral Palsy
Movement of our bodies is influenced by the interaction between the muscles generating the movement (agonists) and the muscles opposing the movement (antagonists). In children with Cerebral Palsy (CP) this balance can be disrupted as agonist muscles become spastic and antagonist muscles waste away (atrophy) due to misuse. This ultimately results in a decline in motor function. TES has been proposed as a mechanism for recreating this balance and its use in CP is a hot topic amongst recent researchers. Early research by Pape (1997) proposed and demonstrated the following mechanisms where the TES is applied to the atrophic muscle causing an increase in blood flow to the area. Furthermore, at night there is a natural increase in the secretion of trophic hormones. When these two principles are combined the result is growth of the atrophic muscle. Early research demonstrated this effect while more recent research has been somewhat inconclusive. Many of the recent randomised controlled trials (i.e. well-designed experiments!) have failed to show any significant benefits. Perhaps one of the key points to note is that further physiotherapy treatment needs to go hand in hand with TES to turn the muscle growth into improved function.
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| TES applied to upper arm and scapula muscles Retrieved from: http://bpirehab.com/page7.html |
Scoliosis
The benefits of TES in patients with scolios (curvature of the spine) have also been investigated and once again the research has provided mixed results. The proposed mechanism for treating scoliosis is to apply the TES to the convex side of the spinal curve. These muscles then become larger and stronger and help to move the spine into a straighter alignment and hold it there. However a review of many recent studies by Lenssinck et al (2005) found that there was little to no benefit from TES in adolescents either alone or as an add-on to other treatment options. As such it is not likely that TES will be embraced as treatment for scoliosis
Duchenne Muscular dystrophy
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| Applied TES over quadriceps. Retreived from: http://www.mikereinold.com |
Research by Scott et al. (1989) highlighted the potential of TES in treating children with Duchenne Muscular Dystrophy (DMD). By applying TES over the quadriceps (thigh) muscles they were able to increase the voluntary strength of these muscles. This particular finding is interesting as the quadriceps are integral for adequate gait function therefore TES could well have a very functional benefit in maintaining the ability to walk. For children affected by DMD difficulty walking is one of the most debilitating effects and many require a wheelchair by late childhood.
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| Threshold Electrical Stimulation (TES) machine |
Spina Bifida
Many children with spina bifida experience paralysis of the legs and poor bladder function. Investigations by Walker et al. (2010) found that TES resulted in increased strength of targeted muscles and participants also reported improved bladder function.
These are just some of the more common neurological conditions where TES is used as a treatment option. Tune in again next week where we delve deep and report the contraindications, precautions for use and costs involved with TES. We hope this information helps in improving your decision making process on the uses and benefits that occur from TES use.
REFERENCES:
Grana, W., Fischer, S., Richards, B. (2007) Muscular Dystrophy. American Academy of Orthopaedic surgeons. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00384
