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Atrophic muscles electrical stimulation in newborn/toddler

Sir,Madame,

My name is Piotr Dzido. I’m medical doctor from Poland, just about to accomplish my training in surgical pathology. I’m a father of four-week-old boy who was born with multiple congenital joint contractures (def: arthrogryposis). This condition may be caused by more than three hundred described medical diseases. The most probable cause of arthrogryposis of my son is amyoplasia: sporadic non-genetic non-progressing condition. My son was barely moving most of his joints of upper and lower limbs starting from the 10th week of pregnancy until his birth. More details concerning amyoplasia: https://patient.info/doctor/arthrogryposis-multiplex-congenita.

The actual condition of his arms is cause by imbalance between agonist and antagonist muscles. Here are the muscles of the upper limb that are hypothrophic/atrophic: deltoid, biceps, wrist and finders extensors.

The weakness of his muscles is caused by disuse atrophy during prenatal period.

We deliver him the most appropriate and conventional treatment managed by orthopedics, physiotherapists and ortho-/ergotherapists. Apart from the conventional therapy, I’m looking for any possible alternative treatment that may increase his muscle strength.

This is how I found the website of another father whose son was born with amyoplasia (http://amyoplasia.com/?page_id=93). His son’s condition was quite similar to the one of my son. As he started using the electrical stimulation of the biceps in the 6th month of age, the first elbow flexion was observed 9 month later. The author of this method, his father, gave little technical information concerning the modules, patterns and parameters of stimulation. As he uploaded a video of his son on youtube (https://www.youtube.com/watch?v=MreSvURG94A) and share few information on his website, we can learn the actual facts: TENS unit, Burst mode, 1 channel with each electrode placed on each bicep muscle. Two 30-min sessions every other day. Here is his explanation of using TENS instead of NMES/FES : http://amyoplasia.com/?page_id=157

I’m writing to you to ask you some questions concerning electrical stimulation of atrophic muscles:

1) If each electrode from one channel is placed on each bicep muscle, what is the track of the electrical pulse? From one electrode, through arm, chest (clavicle, sternum, clavicle), other arm, to another biceps? It seems that the current is in close proximity to the epiphysial regions- I understand that it may harm the epiphysial plate and disturb long bone growth.

2) In spite of the safe/not safe issue, do you have any idea what could be the most optimal electrode placement? The actual difficulty is the length of new-born child limbs: the smallest commercial electrodes are 32mm in diameter while his forearm length is approximately 5 mm long.

3) May you advice the most appropriate type of electrical stimulation and its parameters? In one of the files available in „download section” on this website, it is advised to use the following parameters: Very Weak Muscles / Marked Atrophy 10Hz @ 400 us 2 sec ON / 2 sec OFF (minimum) minimum 1 hr day Minimal contraction .

I would be grateful for any answer and proposition of yours.

Best regard, Dzido Piotr dzidopiotr@gmail.com

Dzido Piotr

2 months ago

Back to General Electrotherapy

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lochingai197
lochingai197

Dear Dzido,

Sorry to hear your situation; but think in this way, it is his luck to have you as his father who can provide him better care.

May I also contribute to your case referring your concern?

1) If each electrode from one channel is placed on each bicep muscle, what is the track of the electrical pulse? From one electrode, through arm, chest (clavicle, sternum, clavicle), other arm, to another biceps?

Suggestion: In each channel, one pair of electrodes (red and black) on one side of biceps, don't cross the chest. WRONG placement: The red electrode on one side and the black electrode from the same channel on the side biceps. The current will pass through the chest and may affect the heart.

1)It seems that the current is in close proximity to the epiphysial regions- I understand that it may harm the epiphysial plate and disturb long bone growth. Suggestion: Electrical stimulation may not directly affect the growth plate, we just worry if the current is too strong, a strong contraction of the muscle will pull a traction force to the site. Usually, a visible contraction is enough, don't worry, it is easy to control.

2) In spite of the safe/not safe issue, do you have any idea what could be the most optimal electrode placement? The actual difficulty is the length of new-born child limbs: the smallest commercial electrodes are 32mm in diameter while his forearm length is approximately 5 mm long.

Suggestion: Actually, we can cut the carbon electrodes into the optimum sizes we need and they will be fully functional. 5 mm maybe too challenging, one rule is that the space between two electrodes should be more or less as the size of the electrode ie. electrodes contract -> short circuit. If the electrodes are too small, the density of the current will be high. Perhaps can wait for free months to let him grow in size first.

3) May you advise the most appropriate type of electrical stimulation and its parameters? In one of the files available in „download section” on this website, it is advised to use the following parameters: Very Weak Muscles / Marked Atrophy 10Hz @ 400 us 2 sec ON / 2 sec OFF (minimum) minimum 1 hr day Minimal contraction.

Suggestion: I think it is hard to recommend the most suitable parameter since it is hard to do control trial research on paediatric cases. Since both the web site and Wendy suggested 10 Hz, I think their clinical experience is convincing enough. For adults, muscle re-education we use 35-50Hz, 150-200us.

If you want to test different parameter, I suggest you can see which parameter requires less current to produce the contraction, then it would be better.

Best regards, Chris

wendy226
wendy226

Hi Piotr Really interesting condition, but of course this must be a very worrying time for you and your family. I will say up front that my background as a physiotherapist has been working with Interferential Therapy - clinically, since 1978. So I will give you my thoughts from that perspective. 10Hz would be my frequency of choice. We have had some amazing clinical results for a variety of conditions using this frequency, which I am including in my second textbook on IFT. As to electrode placement, there is an old technique which I have used on babies with eczema for example, where you put one electrode on your forearm and one on the baby's forearm, or any other available bit of anantomy. Then using a mineral oil or ultrasound gel on your fingers, when you touch the baby (anywhere) then you complete the circuit and of course the current flows. In effect, your fingers become the electrode and you feel what the baby is feeling so you can control the current intensity. What you are then able to do is to pick out the muscle groups that you want by "massaging" the baby across the arms, legs, trunk etc depending on where you want to work. From my clinician's perspective, I have found that you don't necessarily need to get a strong muscle contraction. It is the frequency that has the effect. Out of choice, I would use a home unit Interferential on 10Hz, but you can also get TNS units that give 10Hz. I have just tried this out on one of our university students on clinical placement here and it works happily with two adult sized people, so a baby and an adult would be no problem. (I just wondered if there was enough power from a small TNS unit as opposed to a full sized clinic Interferential unit). The output from our clinic machines is only 1.1w and the power output from your hands in 6w, so we are talking very low power output here considering it is going through you as well as the baby. From the video, it was not obvious that there was any contraction at all of the child's biceps, and we know that the "stronger" muscle groups will pick up the current first - this may be why the child appeared to have his triceps working more ie his elbows appeared to be almost locked into extension. What we are really talking about here is a re-invention of what we used to do up to the about the 1970s, which was faradism, direct current and indirect current. Faradism would stimulate muscles via the nerve supply; direct current would stimulate via the muscle tissue itself and indirect current was a combination of both. Interestingly, all the new "build your abs by electrical stimulation" gizmos are a variation on the old faradic machines.

Most TNS units provide an alternating current and not a direct current as in the second link you mention, so there is no issue with polarity.

My final point is how does the father know that it was the electrical stimulation that worked as it took 9 months to see the effect? I would expect to see a result very much quicker than that - based on nearly 40 years of working with IFT as a specific treatment modality and not as a muscle stimulator. I realise that this is a very specific condition, but I have used IFT for other muscle atrophies of different causes, including disuse atrophy in MSK, post surgery orthopaedics and some neurological conditions. I hope this helps and I would be very interested to hear other viewpoints -and of course, how your son gets on.

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