Hello!!! i am a PT from argentina,i am also in the list reading messages and
obtaining a lot of information...I work with children also an NDT here and i
work with postural reeducation(Kabbat, Souchard and Bobath tecniques,if it
is easy to understand...) i am looking for more information here about
children treatments, what can you recomend me? Ana Villaflor PT
-----Original Message-----
De: D. Fiore <[log in to unmask]>
Para: [log in to unmask] <[log in to unmask]>
Fecha: Lunes 14 de Junio de 1999 03:50
Asunto: FYI and the role of Estim in PT.


>Hi everyone,
>
>I have been inactive on the list for awhile now.  I have enjoyed a lot of
>the information shared and some I have inquired about the effectiveness and
>theory behind it for usage in therapy with my patients.Recently, I have
>come to find time on my hands since full time employment in pediatrics is
>becoming more difficult to find due to insurance companies/HMO"S limiting
>physical therapy services  to children that have been identified thorough a
>comprehensive evaluation.
>
>Let me introduce myself since I have been lurking as a ghost PT. I have
>been a pediatric physical therapist for 10 years and have dealt with
>various ages and types of children and adults with cerebral palsy. I am NDT
>certified with a curiosity about combining the positive features of sensory
>integration. Recently, I had a great informative conversation with Dina, a
>member on the list who was kind enough to share her thoughts and personal
>experiences about NACD. I am now reading more to expand my horizons on the
>subject thanks to her feedback.
>
>In April I read an excerpt from someone who was interested in Estim and why
>it was so difficult to find PTs'  who treat adults with cerebral palsy. I
>would like to expound on that subject if that someone is still out there.
>
>I went to a course that was given in Charlottesville,Virginia regarding
>NMES, TES TENS(what has been addressed by Ms. Elizabeth Thiers, OTR another
>member on the list)and FES. All of these types of Estim are utilized by
>some physical therapists' for strengthening, pain relief and biofeedback
>during treatment of clients with cerebral palsy. I am summarizing the
>outline to help shed some light on the subject. I have used Estim as you
>had described in your comment about Estim and its' benefit. A treated an
>adult with CP-quadriparesis with a TENS unit to provide pain relief and
>reduction in paraspinal spasms from long term sitting in his customized
>wheelchair. I soon had to discontinue therapy due to HMO constraints but at
>least I know he has a home program that includes the TENS unit to reduce
>his spasms and provide him with comfort while he is in his wheelchair for
>the entire day at the sheltered workshop.
>
>Summary of the lecture by Katherine L. Parker MSPT on NMES, TES, TENS and
FES:
>1. Neuromuscular Electrical Stimulation(NMES)is high intensity electrical
>stimulation applied over muscle points for short duration to grow muscle
>fibers for strengthening and motor learning. This unit is supervised by a
>therapist during therapy sessions only.
>2. Therapeutic Electrical Stimulation(TES): Proposed by Dr. Pape of
>Mayatek, Inc. who has studied various cases of providing low level
>stimulation at the sensory level. The unit is worn overnight increasing the
>number of muscle fibers to fire since the "Estim fires the fittest fibers
>first". It is more comfortable for patients to tolerate and her research
>has shown good results in increasing the sensory awareness of the weak
>muscle for better biofeedback during intensive muscle strengthening.
>However, questions have been raised about her research design since her
>sample sizes are small and randomization is difficult. Dr. Pape continues
>to publish her research on TES and train therapists' in TES and how to
>administer the treatment to patients.
>3. Transcutaneous Electrical Stimulation(TENS)is low intensity high
>frequency electrical stimulation used to fatigue muscles in spasms for pain
>relief, increase blood flow to the area for proper nutrition to the muscle
>tissue. It is applied for long or short duration depending upon it's use.
>The effects how are temporary unless the movement or postural deformity is
>corrected in the person's lifestyle.
>4. Functional Electrical Stimulation(FES):High intensity electrical
>stimulation with surface or implanted electrodes positioned for active
>muscle contraction to improve function and/or serve as functional orthosis.
>(Very expensive and invasive by implanting electrodes and reimplanting if
>they become dislodged).
>
>I hope this clarifies your curosity about Estim and its' use by
>therapists'. You all may have many questions so please feel free to comment
>and I will do my best to get back to you with the research. My response is
>not as prompt as some of our members so please be patient. I will try to be
>a friendly Casper ghost PT when I can.
>
>D. Moll MS, PT
>