Threshold Electrical Stimulation
TES, Threshold Electrical Stimulation is used at night while the child sleeps. It is a small battery powered unit with two lead wires, each of these has two electrodes attached at the ends. These electrodes are attached to the child in areas that are designated by a therapist certified in TES.
To find a certified therapist in your location go to http://www.tascnetwork.net/.
TES is a light electrical impulse, not enough to get the muscles to contract, but enough to get the blood to flow to the muscles to promote growth. Because the body repairs itself
the most while we are asleep it is thought that wearing the unit at night would be the most beneficial time. TES can help a child with cp in several ways. It helps the muscles that have atrophied because of disuse grow and become stronger and better able to counteract effects of spastic muscles. This helps the child be able to walk with a more normal gait and straightens the alignment of the spine while sitting. It also helps with bladder control and can be used on the arm to help gain a more functional use of the limb and hand. It can be used after the child has had surgery to help get the maximum benefit from the surgery. TES can be used on hypotonic children as well to help strengthen muscles in the arms, legs, and trunk. This can help the child gain more trunk control and use their limbs more purposely. Hypotonic children a lot of times will, at least initially, show a faster response to the TES therapy then hypertonic children. This is because you are not having to do battle with spastic muscles.
The TENS and TES therapies are not the same. TES is a much lower electrical pulse. Just enough to get blood to flow to the muscles to promote growth. A TENS unit and an NMES unit have a higher electrical impulse. They actually contracts the muscles. TENS units are usually used for pain management and NMES during therapy sessions but not for long durations of time like the TES. TENS and NMES units should not be used at night.
ONE CHILD'S USE OF TES
He is wearing it on his trunk to make his muscle tone more even so the right side is not pulling his spine. Basically to help keep him from developing scoliosis. I can definitely see a difference in his abdominal muscles. He is starting to get a wash board stomach. Also his quads are starting to look more the same size and his muscle tone has visibly increased. He is wetting the bed a lot less , keeping his affected foot in the stirrup easier at horse riding, walking better(keeping foot flat), and his appetite has increased.
UPDATE 7/28/99
Kyle had his TES re-eval and we are moving the pads down to his lower leg--muscle that helps pull the big toe up, and leaving them on the quads too. This is to get him to have a heel toe gait. We are also changing his gastroc muscle high DAFO to a SMO, just above the ankle. This was one of our original goals when starting TES and we thought it would take longer then six months to achieve so we are very excited. His TES therapist can tell a big difference in his gait and he is landing on both his feet when he jumps though he only pushes off with his left you can't tell because he has them both on the floor. He actually stood on his affect leg with the other lifted in the air for the first time during this eval. It really is very exciting to see all this happen so quickly.
UPDATE 9/25/99
I wanted to update everyone on the progress we have made in the last two months since moving the pads exclusively to the leg. Kyle is much easier to stretch. We can get his ankle past 90 degrees with less effort. Kyle can lift his foot up a little when asked which is something he has never been able to do. Kyle has also been able to point his toe up in the stirrup while riding which he was not doing before. He likes his new shorter DAFO much better then the old one. We have lost the improved bladder control at night since moving the pads down. We are hoping to purchase another TES machine after our next evaluation in January so that we can work on the trunk and arm at the same time we are working on the leg.
UPDATE 2/23/00
We are leaving the electrodes in the same placement. Kyle has grown 3/4" so they will be placed a little farther apart. We hadn't been able to use the TES as much since November because of the holidays, chicken pox, travelling, etc. We are going to start using it regularly again. We are hoping that TES combined with the HBO treatments we have and are going to be getting will bring a definite improvement in Kyle's gait. We hope to get him to be able to lift his big toe up; then we can start practicing a heel/toe gait.
We discontinued use of TES from March 2000-July 2001. We have now begun to use it again consistently. When Kyle was reassessed in July 2001, we watched his video from his first assessment through to the last. It was amazing to see how much improvement there has been in Kyle's gait and fluidity of movement. Not all of this is due to TES but to the combination of all therapies we have used with Kyle. We will be adding updates after each of Kyle's 6 month assessments.
