TES, that is Threshold Electric Stimulation

A number of childhood neurological disorders cause so-called central (brain-origin) paralysis, the inability to move the affected muscles. Because the brain–muscle connection is lost and contractions are absent, the muscles gradually deteriorate over time, and this is the most important cause of long-term disability. One way to prevent this is TES, threshold (threshold) electric stimulation.

Pulse – a life-giving force for the muscle

All muscles are connected to the spinal cord and the brain via motor nerves. In a healthy body this connection is continuously "alive" and works in both directions. This regulates, for example, muscle tone: about 10% of your muscle fibers are always in a contracted state and the fibers "take turns". This provides constant support. It plays a major role in returning blood from your body to the circulation during sleep. To put it slightly provocatively, without the continuous, fine pulsation of muscle fibers circulation would stop and blood would coagulate in your body.

When the connection between muscle and nerve is interrupted, the regulatory link also ceases. If the interruption occurs in the spinal cord or above in the brain, the muscles that lose connection gradually stiffen, i.e. become spastic. If the nerve injury occurs after the spinal cord, the muscles, on the other hand, become completely flaccid.

In both cases it is only a question of time before the muscles break down. Without contractions degenerative processes begin. Under microscopic examination the cytoplasm of the atrophied fibers (the cell components responsible for function) decreases and there is little or no actin and myosin (the contractile elements of muscle fiber cells). Eventually muscle cells and fibers are slowly replaced by connective tissue and fat. Once this happens, the paralysis and the resulting disability become permanent. Opinions differ on how long this takes. Most place this period at one and a half to two years.

Contraction – preserves the muscle

In childhood neurological disorders it is very important to preserve muscle condition, because a new discovery or treatment that improves nerve regeneration may appear at any time. However, a nerve can only activate intact muscle. Moreover, increasing stiffness (spasticity) hinders movement, so reducing stiffness helps movement.

Electric stimulation has been used for decades in the treatment of muscles.

Neuromuscular electrical stimulation (NMES, or simply EMS) is a "passive" way of stimulating muscles. The electrical impulse is delivered to the muscle while the recipient does nothing and rests quietly.

In functional electrical stimulation (FES) the patient actively cooperates with the device. When they feel the pulses they also perform an active movement. The stimulation plus the natural movement produce a stronger muscle contraction and thus recovery of function and strength is faster than with passive stimulation.

The essence of both methods is to elicit muscle contraction — and in the contracting muscle the destructive processes described above do not take place.

TES, that is Threshold Electric Stimulation

Threshold electric stimulation (Threshold Electric Stimulation = TES) is a form of muscle stimulation that uses sub-contraction stimuli to promote muscle growth. This means that the pulse intensity is below the sensory threshold. It is so low that it does not produce a visible contraction (unlike NMES and FES, where the focus is on as strong a contraction as possible), yet it is still vital for the muscle.

The exact mechanism of action is not fully clarified yet. The accepted theory is that TES prevents and reverses the muscle atrophy process by increasing blood flow to the muscles. Growth factors and nutrients are transported by the blood. These are necessary for tissue repair. These substances are most effectively pushed into the bloodstream during sleep. Nighttime stimulation of the muscle area increases blood flow and thus more nutrients reach the targeted muscle fibers. Atrophied fibers "repair" themselves and grow.

Under the microscope after TES treatment an increased amount of cytoplasm is visible, as well as regrowth of actin and myosin. The renewed growth of atrophied fibers lasts approximately three to six months. The result is increased muscle strength and improved functional abilities.

TES does not replace other therapies, but it can be used alongside them and considered a complement to any treatment.

Muscle growth requires continuous therapy. TES is generally applied six nights a week, for 8–12 hours daily, for two to four years!

Devices suitable for home TES treatment.

Genesy 300 Pro

• multifunctional electrotherapy device
• TENS | EMS, NMES, FES | MENS, MCR | Iontophoresis
• max. 4 channels (8 electrodes)
• Hungarian language menu

Buy Here

Premium 400

• multifunctional electrotherapy deviceLink to article PubMed Google Scholar
• Lance JW. Spasticity: Disordered Motor Control. Year Book Medical Publishers. Chicago, 1980, issue Symposium synopsis:485‐494. Google Scholar
• Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989;31(3):341‐352. Link to article PubMed Google Scholar
• Folio MR, Fewell RR. Peabody Developmental Motor Scales and Activity Cards. Manual Allen. DLM Teaching Resources, 1983. Google Scholar
• Scheker LR, Chesher SP, Ramirez S. Neuromuscular electrical stimulation and dynamic bracing as a treatment for upper-extremity spasticity in children with cerebral palsy. J Hand Surg Br 1999;24:226‐232. Link to article PubMed Google Scholar
• Taft L. Cerebral palsy. Pediatr Rev 1995;16:411‐418. Link to article PubMed Google Scholar
• Alfieri V. Electrical treatment of spasticity. Reflex tone activity in hemiplegic patients and selected specific electrostimulation. Scand J Rehabil Med 1982;14:177‐182. PubMed Google Scholar
• Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67(2):206‐207. Link to article PubMed Google Scholar
• Pierson SH. Outcome measures in spasticity management. Muscle Nerve 1997;20(6):s36‐s60. Link to article Google Scholar
• Brunstrom J. Clinical considerations in cerebral palsy and spasticity. J Child Neurol 2001;16:10‐15. Link to article PubMed Google Scholar
• Pape KE. Therapeutic electrical stimulation (TES) for the treatment of disuse muscle atrophy in cerebral palsy. Pediatr Phys Ther 1997;9:110‐112. Link to article Google Scholar
• Butler P, Engelbrecht M, Major RE, Tait JH, Stallard J, Patrick JH. Physiological cost index of walking for normal children and its use as an indicator of physical handicap. Developmental Medicine and Child Neurology 1984;26(607‐612). Google Scholar
• Carmick J. Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the spastic triceps surae muscle. Dev Med Child Neurol 1995;37:965‐975. Link to article PubMed Google Scholar
• Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions . Cochrane Database of Systematic Reviews 2008, Issue In: The Cochrane Collaboration. Available from www.cochrane-handbook.org. Chichester, UK : John Wiley & Sons, Ltd. Google Scholar
• Kerr C, McDowell B, McDonough S. Electrical stimulation in cerebral palsy: a review of the effects on strength and motor function. Dev Med Child Neurol 2004 2004;46:205‐213. Google Scholar