Electrical stimulation (e-stim) is a hot topic in rehabilitation. In this blog, we focus on the stimulation of specific muscles or nerves in pediatrics, with a glimpse into the future of spinal stimulation.
There is a range of types of electrical stimulation. Individuals of all ages take advantage of these processes but do not distinguish between them or perhaps may not realize electrical stimulation is being performed. Often, treatments are called something else, like the name of the device, stimulation, or other words.
In pediatrics, electrical stimulation is used in ages from three months to 21 years. Common diagnoses for electrical stimulation treatment are cerebral palsy, spina bifida, spinal cord injury, and brain injury, among many others. Specific purpose uses include healing pressure injuries, enabling swallowing, stimulating gut metabolism, leg lengthening procedures, seizure control, pain, tone (spasticity), function, and many others. Other types of well-known electrical stimulators are cochlear implants, vagal nerve stimulators, cardiac pacemakers, diaphragmatic pacemakers, and defibrillators.
It is important to note that not all children will respond to stimulation, meaning their muscles may not respond. For this reason, before stimulation is considered, children often go through an evaluation to see how muscles do respond.
The thought of putting an electrical current on your child can be overwhelming and frightening. Electrical stimulation is NOT like putting your finger in a socket. A therapist may refer to the pads delivering stimulation as electrodes and the stimulator as a small computer.
For children with sensation, milder electrical stimulation treatments may be used to minimize discomfort, whereas children with decreased sensation may tolerate stronger simulation. However, most stimulators can be adjusted to lessen discomfort and as a child becomes used to the stimulator, the stimulation can be increased. You can have the therapist use the stimulator on your child first to see how it feels and when appropriate, your child increases the stimulation to their tolerance. You will see other children in the clinic using the stimulators without trauma.
Types of Electrical Stimulation
In general, electrical stimulation uses electricity to increase or decrease activity in nerves or muscles. Terms for electrical stimulation vary based on the intended use and/or the type of stimulation.
Transcutaneous electrical nerve stimulation (TENS) is a low-level stimulator for pain control. TENS produces an interruption in the transmission of pain impulses to the brain. It also helps relieve muscle pain.
Electrical muscle stimulation (EMS) is electrical stimulation used in the general population (typically athletes) for strengthening or repairing muscles. In pediatric habilitation and rehabilitation, EMS can be used for muscle strengthening, endurance, and muscle recovery. It is stronger than TENS. EMS is most often considered to be the use of low-frequency stimulation. However, there are high-frequency stimulation options as well (sometimes called Russian electrical stimulation).
Neuromuscular electrical stimulation (NMES) stimulates muscles and nerves. This is similar to EMS but is used more in rehabilitation settings. Uses in rehabilitation include reducing muscle tone (spasms), increasing blood flow, and enhancing range of motion.
Functional electrical stimulation (FES) is electrical stimulation that serves the purpose of creating function in the body where movement is limited. FES has the benefits of reducing muscle tone (spasms), increasing muscle mass, improving circulation and range of motion, and educating the nervous system to stimulate new pathways or repair to allow nerve messaging.
Benefits of Electrical Stimulation
In general, the benefits of electrical stimulation can be quite significant. Because of the intense treatment, benefits can be seen rather quickly in physical attributes such as increased muscle mass, strength, range of motion, and decreased tone (spasticity).
There have been improvements in a variety of body functions such as arm use, walking speed, foot and ankle positioning for walking, bone density, urinary tract infections and function, and bowel function. An example is electrical stimulation to improve sitting balance as a therapeutic treatment with excellent results. Once the child’s body and mind have learned sitting posture, it is possible, in some diagnostic categories, to eliminate the therapy while others use it for longer periods of time.\