Can I or Can’t I?

Hello fellow TES researchers! We have picked over articles and reputable sites in order to gather information in the hopes of enlightening you on the precautions and contraindications of the application of TES. In the following we have found some obvious and not so obvious contraindications (we cannot use this particular treatment), precautions (we need to take care) and some general good sense advice.

The Ideal Candidate:

With TES being one of the less invasive and restrictive treatment options when compared to others such as surgery and bracing, it would be nice to say that it was an appropriate option for all children with motor deficits. However, as the research literature shows the results of TES treatment are quite variable and are limited by contraindications. Perhaps the key to optimising the effectiveness of TES is in selecting the individual children who are likely to benefit. 

Ø  As the treatment regime is lengthy it is important that both the child and the family have the ability and desire to adhere to the program
Ø  Candidates and their support system must be motivated to work hard towards change/improvement
Ø  The severity and type of the child’s disorder must be TES appropriate
Ø  Specific ages where children are most likely to benefit have not yet been established. It has been suggested that during puberty the body is geared up for growth and therefore may respond to TES with a greater increase in muscles bulk

Contraindications and Precautions:

Before the application, any site that is to receive the treatment should be tested for sensitivity. This will include hot-cold and sharp-blunt discrimination tests to ensure the patient has adequate sensory ability to detect any equipment (or practitioner) malfunction. These tests are standard and provide quick and easy feedback to eliminate easily preventable problems. It should be noted that children receiving treatment need to be able to provide appropriate feedback to ensure the TES is received at the correct threshold. Cognitive impairments and infancy may therefore become a contraindication.

The following contraindications are generalized for low level electrical stimulation such as TES;

Ø  Cancerous tissue (malignancy)

Ø  Specialised tissue (e.g eyes and testes)

Ø  Active implants such as pacemakers

Ø  Tissue bleeding

Ø  Broken tissue

Ø  Epilepsy and

Ø  Active epiphysis

Active epiphysis.
Retrieved from: http://www.gla.ac.uk/ibls/US/fab/tutorial/generic/growth4.html

We think the key point is to remember that each child is an individual and needs to be treated and assessed as so. Each will have their own opinions and response to treatment. If a child finds the tingling sensation disrupts their sleep this may hinder their physical and emotional development and hence the cost will ultimately outweigh the benefits. 

Precautions are not absolute but they do dictate the call for diligence while applying TES especially on children. The precautions associated with low level electrical stimulation include;

Ø  Any peripheral neuropathies
Ø  Current pain
Ø  Recent trauma to the treated areas and surrounding tissue
Ø  Devitalised tissue and
Ø  Local circulatory insufficiencies

A noteworthy point is to be cautious with adipose tissue. Unfortunately in today’s society we are seeing an increase incidence in childhood obesity and with treatments such as TES and other electrical stimulation, higher intensities are needed to reach the sensory threshold or stimulate the deep underlying tissues which may cause pain or autonomic reactions.

A good physiotherapist will also;

Ø  Check for redness under the adhesive pad in case of allergies or incomplete adhesion of pad which may cause burns

Ø  Maintain TES device as well as electrodes and adhesive pads

Ø  Apply device to themselves before patient application

Ø  Educate on use at home



Electrode burns.
Retrieved from: http://radiographics.rsna.org/content/24/1/41/F3.expansion.html



Most machines have built in safety features such as an automatic shut off to prevent burns or shocks and an output limiter to prevent overstimulation. Despite the list of contraindications and precautions TES is safe and effective when applied in accordance to guidelines.

 We know this is a lot to process (and this is the short of it!) but hopefully, so far, we have made Michaels Jacksons pre-teen afro seem like a military short back and sides. So again, we have braved the literature, bleary eyes and all, to bring you our digestible summary of specific dosages and costs associated with TES application… Coming Soon!

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.

Olds, T., Tomkinson, G., Ferrar, K., Maher, C. (2010) Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. International Journal of Obesity. 34, 57-66

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

Pape, K., Kirsch, S., Galil, A., Boulton, J., White, M., Chipman, M. (1993) Neuromuscular approach to the motor deficits of cerebral palsy: A pilot study. Journal of Paediatric Orthopaedics, 13 (5), 628-633

Walker, J.,  Ryan, S. & Coburn, T. (2010). Does threshold night time electrical stimulation benefit children with spina bifida? Clinical Orthopaedics and Related research, 469(5) 1297-1301

Watson, T. (2012) Contraindications. Electrotherapy on the web: An educational resource. Retrieved from: http://www.electrotherapy.org/modalities/contragrid.htm#tens