For many people the idea of attaching any electrical device to a child may seem unsettling. When applied correctly TES consists of a lower dose than most other electrical stimulation treatments which is one of the characteristics that makes it more favourable in children. In fact children themselves have referred to TES as feeling like ‘butterfly kisses’ or a ‘tickle machine’. While these descriptions may quite adequately describe what the child is feeling lets look a little more ‘technically’ at some of the parameters.
Dosage:
As mentioned previously TES is often considered alongside NMES as both are used to treat muscle weakness in similar conditions. The treatment parameters and mechanism of action however are markedly different.
The key characteristic that differentiates TES from other electrical stimulation modalities such as NMES is that it is applied at the patients sensory threshold (2-10mAmps). This means it is applied at an intensity where the child can feel it (tickles or butterfly kisses!) but it does not cause muscle contraction and certainly isn’t painful. When selecting between NMES and TES the initial strength of the muscle should be considered. A grading of 3+/5 or less should be treated with TES. Higher than this and NMES or a combination of daytime NMES and night time TES may be used.
During TES and NMES treatment the total current applied can be the same but the duty cycle differs. Instead of a short duration high intensity stimulus as in NMES, TES provides a longer duration, lower intensity stimulus.
 |
| Dosage Parameters for NMES Vs TES. Pape (2004) |
Individual treatment sessions occur overnight for 8-12 hours 6 times per week. It can take 6-8 weeks to increase muscle volume and 6-12 months to improve function. This long time to effect may be one of the reasons that many experiments don’t produce meaningful results as they simply aren’t allowing enough time for effects to develop.
Total program length varies greatly between individuals. This has been investigated in children with CP and studies so far suggest that mildly affected children require 18months to 2years and severely affected children require 3-4 years. Secondary treatment may be required during puberty as the body grows and changes rapidly.
Summary Table
Parameter
|
Value
|
Intensity
|
Sensory Threshold; 2-10mAmps
|
Treatment Duration
|
8-12 Hours
|
Treatment Frequency
|
6x/wk
|
Time to effect:
· Muscle Volume
· Function
|
6-8Wks
6-12Months
|
Total Program Duration
|
18months-4 years
|
Cost:
As we all know medical bills can add up very very quickly!!! While it would be wonderful to have an unlimited healthcare budget, unfortunately cost is something that has to be considered. The good news is that TES is a cost effective treatment modality. The ability to use it as a home based treatment reduces the cost of health care appointments (not to mention the hassle and cost of driving there!!) – every little bit counts!
The cost of a TES machine itself is about US$825. It can only be ordered by a registered medical professional such as your physiotherapist. As mentioned in previous posts TES must be integrated into an appropriate physiotherapy program in order to turn TES induced muscle growth into functional improvement. The cost of such a program is hugely variable between individuals, practices, treatments and countries.
Unfortunately, in the USA and likely in other areas of the world TES treatment is not subsidised by Medicare due to the inconclusive research base.
With all things considered, if TES is safe and beneficial for an individual child it is one of the more time and cost effective treatment options in today’s physiotherapy world.
References:
Dali, C., Hansen, F., Pedersen, S., Skov, L., Hilden, J., Bjornskov, I., Strandberg, C., Christensen, J., Haugsted, U., Herbst, G. & Luskjser, U. (2002). Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial. Developmental Medicine and Child Neurology, 44, 364-369.
Pape KE. (1997) Therapeutic electrical stimulation (TES) for the treatment of disuse muscle atrophy in cerebral palsy. Pediatr Phys Ther 9 110–112.
