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Resources

  • Before and After TT
  • Bony Improvement - Before and After - Mod-Quad and TT

 
15-Oct-04 2:00 PM  CST

Threshold Electrical Stimulation (TES) and the TASC Network Model of Recovery from Brachial Plexus Injury (BPI)

(Click here to download full article)

In the old days, it was accepted medical wisdom that the only way to effectively change the growth pattern or strength of a muscle was to work the muscle. In other words, the muscle would have to contract. A recent article examines the research evidence for both NMES and TES used in children with Cerebral Palsy. (1) Although much of this research is considered anecdotal, each technique has one "scientifically valid" study that documents change. When we first introduced TES protocols to the health care community, there was a fair amount of skepticism. However, 15 years later, it is accepted that TES, using a low level of stimulation overnight, during sleep, causes growth of muscle.

In the companion article to this piece, Richard Roseboom and his mother, Vanda, relate their experiences after adding TES into a their active exercise program. Richard and his family are very good examples because they have been active for years and are very compliant with their exercise protocol. They had not been sitting idle hoping to get better. However, in spite of all the work, Richard had reached a plateau and his shoulder stability was NOT getting better. With TES and the Model for Recovery coaching, new muscle growth was achievable, even in a teenager, Actually, Richard's exercise program works better because he is a teenager. Puberty is a great stimulus for growth. During puberty, the body is primed and readied to grow. 

As well as new muscle growth, many patients have commented that there is an apparent increase in sensory awareness after relatively short periods of time using TES at night. Richard was able to "find" his back muscles, contract them and so strengthen them. This observation is interesting to me as a scientist, as there are excellent animal research studies that relate to this finding. In animals, low-level electrical current has major effects on the re-innervation process. After direct nerve injury, applying a low-level electric field improves not only the speed of the regeneration, but also the quality of regeneration, with an improved number of nerve sprouts. (2-4) There is some interesting information on the actual mechanisms of this change in animal studies but equivalent human studies have yet to be done. I think it is a very interesting area of further research and we can all look forward to more investigation in the coming years.

However, as both Richard and his family will attest, the new growth of muscle, while exciting, is not enough to change function. In order to change function that new muscle has to be strengthened and integrated into daily use. The TASC Model for Recovery was developed to help individuals integrate the available information into a focused plan of action. Making a plan and then taking action is the only way to get a better result.

The Model for Recovery
"How to achieve your child's personal best"

In the Model, we draw on a wide variety of treatments, technologies, medicine and surgery…whatever is needed to get the best possible result. Of course, this type of treatment model makes good researchers want to tear out their hair! One of the problems with doing research in humans compared to animals is that TES, or any other intervention used in Brachial Plexus Injury rehabilitation, is difficult to evaluate by itself. Best possible recovery from BPI requires a multi-disciplinary approach. Many interacting therapies may need to be used at the same time. In contrast, the aim of formal research studies is to isolate the individual variables and then study them one at a time. The investigators work hard to try to isolate the effect of just one therapy. The problem with this approach is that it is like doing great surgery without any therapy. We all know the results that you would get without therapy are pretty miserable. No matter how skilled the surgeon, therapy pre- and post-surgery will improve the outcome. In Richard’s case, TES helped his very atrophic, weak muscles to grow. Then he could learn to activate them. And now, he is working to strengthen them in active movements. All the techniques he has used have helped and no one treatment would produce those results if used alone... (Click here to download full article)


 
For additional information on this article, please contact:
 
Rahul Nath
(713) 592-9900
drnath@drnathmedical.com
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Source: Karen E. Pape, MD, FRCPC, FAAP Website: http://www.drnathbrachialplexus.com
 
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