TES - You're in control

Looking for an answer to the acronym TES? Google TES and you will find the following; Total Energy Solution, Thermal Emission Spectrometry, The Employment Solution, blah, blah, blah… You get our drift. But if what you’re looking for is information on “Threshold Electrical Stimulation” then you have come to the right place. So we’re guessing your first question is TES…?

Threshold Electrical Stimulation (TES) previously known as therapeutic electrical stimulation is the delivery of low intensity electrical stimulation (e-stim) during sleep via electrodes adhered to the skin.  TES is delivered at the specific sensory threshold of the patient, usually between 2 – 10 milliamps (mA). This means that the patient can detect the stimulus but the intensity is not high enough to cause the muscles to contract.

Current available TES machine

So what is TES used for? Its uses are predominantly aimed at children with neurological diseases particularly spastic diplegia related to Cerebral Palsy (CP) and other motor disorder (e.g Spina Bifida). These children are sometimes treated with an alternative e-stim called Neuromuscular Electrical Stimulation (NMES) which uses short periods of relatively high intensity to cause a muscle contraction to occur. A valid option, but recent research has found that some children report discomfort while receiving NMES and similar studies have found TES to be just as beneficial without the uncomfortable side effects.

How exactly does TES work? TES is commonly administered overnight for 8-12 hours, up to 6 nights a week. It’s aimed at patients with 3+/5 or less muscle weakness (a common pathology associated with neurological disorders) in the Medical Research Council (MRC) muscle assessment scale.

The mechanism of action of TES is relatively unknown however it has been reported that an increase in localised blood flow combined with the heightened secretion of trophic hormones (Hormones which target endocrine glands) during sleep can potentially result in increased muscle bulk to the target area. In addition TES in paediatrics has the potential to improve:

·         muscle strength

·         voluntary motor function

·         gait and step length

·         continence and  

·         risk of falls in patients with CP

Hopefully this has answered some of your initial questions. Drop in next week for some “stimulating” information on the use of TES in a selection of specific paediatric neurological conditions.

References:

Dali, C., Hansen, F., Pedersen, S., Skov, L., Hilden, J., Bjornskov, I. (2002) Threshold electrical

stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled

clinical trial. Dev Med Child Neurol.  44(6) pg 364-369.

Han, S., Kim, M., Kim, J., Hong, C., Kim, J., Noh, J. (2004) Intravesical electrical stimulation improves neurogenic bowel dysfunction in children with spina bifida. J Urol. 171 pg 2648–2650.

Kerr, C., McDowell, B., McDonough, S. (2004) Electrical Stimulation in Cerebral Palsy: A review of Effects on Strength and Motor Function. Develop Med Child Neurol  46 pg 205-213.

Pape KE. (1997) Therapeutic electrical stimulation (TES) for the treatment of disuse muscle atrophy in cerebral palsy. Pediatr Phys Ther  9 110–112. 

Steinbok, P,. Reiner, A,. Kestle, J. (1997) Therapeutic electrical stimulation following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: a randomized clinical trial. Dev Med Child Neurol 39(8) pg 515-520.