Electrical Muscle Stimulation Treatments for Cerebral Palsy

Ninety percent of children with cerebral palsy have muscle spasticity as their dominant or exclusive impairment. EMS (electrical muscle stimulation) is the elicitation of muscle contracture through electronic stimulation and is sometimes used to treat children with spastic cerebral palsy. When combined with the right physical therapies, experts have demonstrated that EMS can improve overall motor function, increasing the child’s ability to perform physical tasks such as walking.

There are two ways of approaching EMS. The first is called NMES (neuromuscular electrical stimulation) or FES (functional electrical stimulation). The procedure, done only by a medical professional, involves giving specific muscles or muscle groups short bursts of electrical impulses designed to mimic the normal communication between the brain and the muscular system. Hopefully this can retrain the muscles to respond appropriately to the desires of the brain in a way they frequently don’t in someone suffering from spastic CP.

TES (threshold electrical stimulation) is very different. It involves much lower voltage and can be directed at a specific muscle or muscle group over a long period of time. It can be administered by the patient or a family member and can even take place overnight while the patient sleeps. It does not induce contraction, but instead is used to relieve patients of some of the discomfort and pain that comes with spasticity.

The way that NMES works is that electrodes are placed onto the skin in the vicinity of the muscles that are either in atrophy or have weakened due to spasticity. The electrodes are connected to a small generator. The current is low and rarely causes discomfort to the patient. The intent is to force the muscle to contract in a way that the brain is failing. The response is not dissimilar to having your reflexes induced by tapping on the knee. With TES, the procedure can be administered by a parent at home.

Unfortunately, with spastic cerebral palsy, any improvements brought about by EMS are temporary. The damage to the neuromuscular system is irreversible and the brain really can’t be trained to stimulate the muscles appropriately on its own. In most cases, full-time relief from the impairment of muscle spasticity requires approximately 2 hours of EMS every day of the week. Even then, any prolonged break from treatment will probably result in the abnormal spasticity returning to pre-treatment levels. For many, the benefits, however temporary, are worth a lifetime of daily treatment.

Because of the temporal nature of the benefits, many experts in the cerebral palsy world consider electrical muscle stimulation only as a supplement to standard treatments. Exercise and physical activity are still seen as having more enduring benefits to the ultimate health and well-being of children with cerebral palsy. But the debate is ongoing. Other experts believe that with further advancements, EMS alone may be used to treat and improve, at least, the smaller muscle groups such as in the forearm or wrist. Whether or not EMS can one day stand alone as a treatment for EMS remains to be seen, but it is at least worth consideration as an element of your child’s physical therapy.

Isn’t ADHD Just An Excuse For Lack Of Discipline?

ADHD or Attention Deficit Hyperactivity Disorder is a disorder that commonly affects children by making them hyperactive with low attention span, it has been seen that boys are inflicted more than the girls. The typical symptoms include difficulty in controlled behavior, low focus and attention span and hyperactivity. But considering the increasing levels of behavioral issues plaguing schools and homes, isn’t ADHD just an excuse for a lack of discipline?

Attention Deficit Hyperactivity (ADHD) symptoms

Most parents of children diagnosed with ADHD complain of violent behavior patterns with children of 7 to 9 years hitting siblings and others that prevent them from doing things they want to do. As per studies conducted on ADHD and childhood behavior patterns, here are some of the common symptoms:

• Distraction

• Forgetfulness and daydreaming patterns

• Low attentions span

• Poor listening skills

• Poor concentration

• Heightened activity- running, inability to play quietly

• Aggressive and violent behavior

However, aggressive behavior and anger is a common pattern seen in young and older aged children diagnosed with this disorder. It has been seen that feelings of frustration coupled with lack of communication of emotions vent out as aggressive and violent behavior patterns.

Though they are developmentally delayed, it has been seen that the urge to resist aggressive behavior is lacking. But the fact that children have communication issues along with poor focus, reinforcement of instructions does help. But it is also seen in kids with poor discipline and lower levels of parental control.

Can poor parenting skills lead to misdiagnosis as ADHD?

But coming back to the question that isn’t ADHD just an excuse for a lack of discipline, it is true that in some cases, indiscipline is camouflaged by ADHD. Poor parenting skills compounded by lack of discipline can label the kids afflicted with ADHD. But not all children diagnosed with ADHD are categorized such due to lack of discipline. This is a serious behavioral disorder that continues to adulthood unless there is medical and therapeutic intervention. Though there is no cure for Attention Deficit Hyperactivity Syndrome, some medicines and behavioral therapy is advised by physicians depending upon individual evaluation.

Oftentimes, it is easy for parents to put the blame on the children citing medical disorders than introspecting on their own parenting skills. They take the child from doctor to doctors till the symptoms are correlated with a behavioral problem, which is one of the reasons that ADHD is misdiagnosed. Most of the children with such poor parenting and discipline issue, who are labeled as ADHD, get away with misbehavior. However, the children that are misdiagnosed and put on drugs suffer lifelong side-effects which could have been avoided with little discipline.

Thus, in a way, isn’t ADHD just an excuse for a lack of discipline? Yes, it is in some cases while in others, it is for the betterment of the child to receive proper guidance and therapy to enhance communication skills and increase focus. It is the role of parents to wisely notice the symptoms, stay balanced and the skill of the doctor to be able to diagnose correctly.

ADD Fad or Fact?

Attention Deficit Disorders has become a catch phrase in educational circles. When I started my clinic almost 10 years ago, a diagnosis of ADD resulted in puzzled and suspicious looks from parents and teachers alike. However, the pendulum has swung the other way. It has become a substitute for a hyperactive child. Parents and even some professionals make this diagnosis by ticking off a number of symptoms that they may have observed in the child. This has led to misdiagnosis and misuse of medication. In our fast track lives, a quick diagnosis with a quick solution has replaced careful clinical assessment and multimodal interventions.

For the novice reader, ADD stands for Attention Deficit Disorder, a common mental disorder seen in 10 to 20 percent of children. I hesitate to call it a mental disorder because it’s signs and symptoms are not pathological. It is a dimensional not a categorical disorder i.e. many of the symptoms may be seen in the average child or person but in a person with ADD they are severe enough to cause problems in education, behaviour and or social fields.

ADD is a complex disorder not a checklist disorder. It can start insidiously wherein subtle signs are missed in early childhood because they are mainly related to inattention. They may also present with a bang with a hyperactive child. Nonetheless, these children may even present later in life if they are very bright e.g. in high school or even college. ADD can mimic other problems. A child traumatised by a mixture of unrealistic expectations, harsh punishments and inappropriate curriculum can present with inattention and restlessness. Anxiety, especially posttraumatic stress disorder and separation anxiety can also cloud the picture. Other disorders like Juvenile Bipolar disorder or Asperser Syndrome wherein hyperactivity is also a symptom can complicate the diagnosis.

ADD also has a wide spectrum of clinical presentations. From an inattentive, quiet and withdrawn child (Inattentive ADD) to a restless, impatient and impulsive one. In fact Dr. Amen has described 6 types of ADD each having their own brain images on the SPECT machine. No two children with ADD are same. Co-morbid conditions like anxiety and depression can change the clinical picture. Language difficulties, either spoken or written along with Specific Learning difficulties complicates the clinical presentation. Environmental conditions also affect the ADD child. Highly mobile expatriate societies as those seen in Dubai, Hong Kong and Brussels see a higher rate of ADD in their student population. One of the reasons being changing school systems, anxiety with relocation and other environmental factors that aggravate a mild predisposition to ADD to a blatant one.

The other feature that can confuse parents and teachers alike is that ADD is not an absolute deficit. This means that symptoms can fluctuate. A child with ADD can be well focused in a subject he enjoys but can become very restless and difficult in those he doesn’t. Thus an ADD child can sit and work on a computer for hours but cannot sit and read (even if he is good at reading). Some readers may feel that this is true of many people. However, those without ADD can make themselves pay attention to uninteresting topics when they know they have to. Also many ADD children may not be educationally impaired.

Early diagnosis and multimodal intervention is the key.

Research has shown that ADD is a life span disorder that can be seen to follow the ADD child into adulthood. Untreated ADD can lead to many complications. From emotional disorders to psychiatric disorders; from school failure to school dropouts and from behavioural problems to felony, a child with ADD can develop many problems.

I cannot end this article without touching on the crucial factor of medications. Many parents and teachers feel alarmed by use of behaviour changing medications, especially if the child is not very difficult to manage. However, ADD is a neurochemical disorder. That means it is organic in origin and is not caused by bad parenting or poor schooling. (Though they can aggravate it). Medication is necessary to prevent complications and ensure academic and social success. Stimulant medications can improve attention and reduce impulsive and restless behaviour. They can improve academic efficiency and performance and hence avoid complications of low self-esteem. They can improve behaviour and attention and hence improve social acceptance. However, social skills, remedial help for learning difficulties must be given.

To conclude ADD is a complex disorder which impacts the person life long. Diagnosis and therapy must be long term and multimodel.

Premature Baby Has Congenital Torticollis? Try These Simple Stretches

Congenital Torticollis

This is a fairly common condition that affects 1 out of every 250 babies born in the United States. If your baby has this condition you will notice that she keeps her face turned toward one side of her body more than the other. In addition, her head will tilt or bend to the opposite side. Parents of infants with this condition have also reported that they were able to feel a small but noticeable lump in the center of the Sternocleidomastoid Muscle (SCM) on the side of the baby’s neck. The SCM is a large rope-like muscle that begins on the scapula and ends on the base of the skull. This muscle is responsible for tilting and rotating the head.

How is Congenital Torticollis discovered?

Congenital Torticollis is usually found during a routine examination by the baby’s pediatrician within the first month or two after the baby’s birth. Most cases of Congenital Torticollis are subtle and often go unnoticed by parents who may not know what to look for. Once your doctor has ordered X-rays to confirm the diagnosis, he may also recommend that your baby receive physical therapy.It’s important to begin treatment as soon as possible for this condition because if left untreated Torticollis could cause your baby to develop Plagiocephaly (Flat Head Syndrome), a condition that causes the back or side of baby’s head to become flattened due to prolonged pressure on the same part of the skull. Premature babies are especially susceptible to Plagiocephaly because their skulls are softer than the skulls of full term babies.

How is Congenital Torticollis treated?

This condition may be corrected using simple stretches and positioning at home. In addition, Torticollis may be resolved by turning your baby’s face to the opposite side each time you put her to sleep.

1. The “Head Turning” neck stretch

  • Put your baby to lie on her back on the couch with her head close to your body.
  • Hold a brightly colored toy about 4-6″ in front of her face and move it from side to side so that she has to turn her head to track the toy.
  • As your baby turns her head to look at the toy, move the toy down to the surface of the couch so that she has to turn her head in the opposite direction from the side that she normally keeps her head turned toward.
  • Put your hand on the side of her head to keep her head turned towards her non-favorite side for as long as she can tolerate it.
  • Rub her tummy and talk to her to keep her calm during this exercise.

2. Football Stretch (For Right Side Torticollis)

  • Hold your baby with her back against your chest.
  • Tilt her body so that she is leaning at a 45 degree angle with her head towards your right arm.
  • Slide your left arm between her legs and up across her chest and hold down her right shoulder with your left hand.
  • Use your right hand on the right side of her head and gently tilt her head sideways until her left ear touches the top of her left shoulder.
  • You are now stretching the right Sternocleidomastoid muscle.
  • If your baby has left side torticollis reverse the above directions to stretch the left Sternocleidomastoid muscle.

3. Stretching while bottle-feeding (Right Side Torticollis)

  • If your baby has right side Torticollis then she would have difficulty turning her head toward her right side.
  • Hold baby in your left arm and begin feeding her with a bottle.
  • When she is feeding comfortably remove the nipple from her mouth.
  • Touch the nipple to the right side of her mouth and cue her to turn her head to the right to get the nipple back into her mouth.
  • Repeat this process of removing the nipple from her mouth and coaxing her to head to the right side to get the nipple back into her mouth until her head has turned all the way to the right side.
  • Complete her feeding with her head turned all the way to the right side and this will stretch her right SCM muscle.

This condition should gradually resolve itself if you stretch your baby’s tight neck muscles 4-5 times every day.