United Brachial Plexus Network, Inc.

What's the difference between the EMPI unit and the other one that everyone seems to be using? Our script is for the EMPI. Should I ask our dr. for the other one?

WHAT IS TES? IS IT SOME KIND OF E_STEM? I WOULD LIKE TO KNOW FOR MY 8 MONTH OLD. IS THERE A HANDBOOK FOR DEVICES FOR THIS INJURY?

We have used e-stim (functional) on an off since Juliana was about 18 months old. We have seen positive results from it. We botoxed her triceps and e-stimmed the biceps and had a wonderful result. You have to be careful and learn the proper technique or have a qualified ot or pt doing it. We have a unit at home that we bring to therapy. They do the deltoids and scapula at therapy and I do wrist extensors at home.

I think the point about "lasting effect" is an interesting one. We can't compare the effect that estim or any other modality would have on a normally innervated muscle to the effect it would (could) have on a bpi muscle. These muscles are not properly innervated--so how can you compare??? If doctors are looking at stroke victims, for example, it still isn't an equal comparison. These people have had normal innervation for their whole lives-until the stroke. Our kids have never had normal innervation. My point is that we have to rely on anecdotal information. A study of tes or estim would have to be a study on bpi kids for it to be meaningful for me. We used e-stim on Juliana because it made sense and because our ot had years of experience with bpi kids and the use of estim on them.

I admit that we don't use tes--a variety of reasons...But, when so many people respond that it is helping their kids...how can a doctor say it doesn't work???

In dealing with Juliana's injury, we try just about everything.

hope it helps,
claudia

Ok, all this is new to me.
I am in the UK, I am unsure if it is recomended over here.
Josh is almost 5, as you may know we are trying to build his shoulder muscle to weight bearing. Will this help?
Am I too late?
Does anyone else in the UK use this, or am I being kept in the dark?
Does my PT even know of this therapy?
Does my specialist.... it has not been mentioned.

All these questions... !

Thanks for the info
Pauline

From what I know it is not used over there. It would be interesting to know why. Are they not even aware of it? Is it a money issue and units would not be paid for? Or do they not believe in its longstanding results?

I thought that tes was to improve circulation and bring the growth hormones to help make sure that the arms don't end up with a difference in bone growth especially length. And this is indeed one of the uses for it.( TES -threshold electrical stimulation doesn't actually cause the muscles to contract, it is a lower level of stimulus that stops short of contracting the muscle and is applied over extended periods of time often through the night as the child sleeps.) When I asked a bpi doctor about this he said that my son had even bone growth but that the muscles needed building so we should do NMES which actually makes the muscle contract. I then went to see Leslie Mckibben who is trained in tes and nmes and she told me that there are four stages or categories of muscle. 1. the largest strongest type being the athletic muscle. 2. the next largest strongest muscle fibers of a normal used muscle 3.the atrophied muscle that is not used as much due to injury or nerve damage or immobilization, that has smaller and weaker muscle fibers.4. the severely atrophied muscle due to not using due to nerve, muscle damage or injury or imobilization. these muscle fibers are not only smaller and weaker but they are also very brittle. Leslie told me that she believes tes would be important because if you go srtaight to NMES on an atrophied muscle it is too much on the weak brittle muscle fiber and you end up tearing and destroying more muscle tissue. She said you build the muscle from a type four muscle to a type three muscle first by using tes or a type three to a type two, or even a type four to a type two , so that the muscle gains some bulk and flexibility or suppleness before going to NMES to build strength. This was an interesting bit of information I had not come across before so I thought I would pass it along.

Another difference of opinion. Sometimes it can drive you crazy since there are so many darn varying opinions. I sure hope we did not cause damage and from how my child is doing I sure don't think so. We did not use TES first. We used NMES starting around 5 months old, three times a day for 20 minute sessions. This was highly recommended by a doctor we have seen along with a therapist who actually has written a published article on bpi's. I know some places don't agree, but then again they never experimented with it either. My child has had an amazing recovery based on the severity of the injury. He amazes people and doctors constantly and I have a strong hunch (could be wrong though) that the frequent NMES use had A LOT to do with it. The only thing we were warned about is to never place them on the growth plates which obviously we would not do since we had clear instructions on exactly where to place them.

We use NMES in our therapy sessions and I am currently looking into getting our own unit to do it at home as well. Currently, based on what I've learned regarding TES, Caleb's needs are such that we feel he doesn't need this type of e-stim. We've used NMES with Caleb for about a year. He turned 3 in August.--Kari

Tammie - Sarah started using TES about mid-September on a setting of 4. After about 6 weeks, we were testing the setting on the unit to see where she felt it, and I took it to the maximum (12) and she didn't even flinch (when I put it on my arm at that setting, it tickled a lot and even hurt a little). I did it again a few days later for her PT, who said she probably had some sensory deprivation in that arm. A week later I went to show this to her OT who is following her TES therapy, and lo and behold, she noticed it on a 6!!! She is getting stronger and is holding her arm closer to her body (instead of the birdie wing position) - this is a lot of improvement in less than 2 months!