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