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I am an occupational therapist who works with many of the children with AMC. I am curious about the Jace Method and use of e-stim to help the muscles.
1. Why do you use the TENS and not an FES unit?
2. How do you get a muscle contraction when you place the electrodes on two different muscles?
3. Have you been trained in the use of electrical stimulation? As a therapist, we have to take hours of courses and receive a certification to use modalities.
4. How did you document change in the muscle strength?
5. Can you put me in contact your child’s therapist?
First off let me say thank you so much for your interest in The JACE Method™ as an OT. You are not the first OT/PT to contact me but this gives me hope that there are specialist out there that can make a difference for many children with this condition. Please feel free to call me if you would like any additional information 318-613-5295
1) Our unit of choice is a TENS unit that just so happens to have a “Burst Mode” setting. Overall this seemed to be a device that would achieve benficial results but also gentle enough to be tolerated by an infant. I know I know… I’ve read and heard time and time again how TENS is used for pain and not Functional Electrical Stimulation; however, FES is also for rehabilitation of the brain (stroke patients) and is trying to re-educate the brain on how to perform the function. Usually muscle is already present and nerve functionality has been impaired. Also FES units frequency is stronger so use on infants is a very delicate subject. In the case of amyoplasia alot of times there is very little muscle to begin with and the nerve to brain deep reflexes are present (at least with Jace our neruologist determined his nerves reflexes were present) but the extremity lacks the muscle to perform the action. The goal isn’t re-educating a muscle that already exsist but instead to reverse atrophy by making the muscle contract every two seconds and promoting muscle fiber growth by aggrivating the sattelite cells. This disruption to muscle cell organelles activates satellite cells, which are located on the outside of the muscle fibers between the basal lamina (basement membrane) and the plasma membrane (sarcolemma) of muscles fibers to proliferate to the injury site (Charge and Rudnicki 2004). In essence, a biological effort to repair or replace damaged muscle fibers begins with the satellite cells fusing together and to the muscles fibers, often leading to increases in muscle fiber cross-sectional area or hypertrophy. This process has been documented to happen following work outs or slight bruising and even happens for fast twitch muscles via performing everyday activities. Our decision to purchase this unit was based on the versitility of the device and the range of settings. With TENS being the gentler form of EStim and with Jace being very young we decided to start there. It has also been well documented that “Burst Mode TENS” intensity can be modified to cause a moderate muscle contraction on adults so caution must still be taken. We will be purchasing a FES unit for Jace and look into using it once he turns 2 years of age. Let me also point out that children are filled with stem cells. Science is just now beginning to understand how stem cells behave and what can influence that behavior. To quote a recently published article “Here, we report that mild electrical stimulation strongly influences embryonic stem cells to assume a neuronal fate. Although the resulting neuronal cells showed no sign of specific terminal differentiation in culture, they showed potential to differentiate into various types of neurons in vivo, and, in adult mice, contributed to the injured spinal cord as neuronal cells. Induction of calcium ion influx is significant in this differentiation system. This phenomenon opens up possibilities for understanding novel mechanisms underlying cellular differentiation and early development, and, perhaps more importantly, suggests possibilities for treatments in medical contexts.” ref: http://onlinelibrary.wiley.com/doi/10.1634/stemcells.2006-0011/full Even though this research was published on embryonic stem cells I’m hopeful that adult stem cells may also be effected by slight electrical stimulation.
2) The guide on the bottom of our estim page will better explain electrode placement. The electrodes pass an electrical signal from the electrode through the body. This can be a single muscle or multiple. Example from the forearm to the biceps. The current will flow from negative to positive pole and cause the stimulation on the muscles on both contacted electrodes. The muscle’s contract under both electrodes and do not distinguish polarity through experimenting with the unit on myself. Please note that polarity will affect the cells and tissues ref:http://hkeducationcenter.com/courses/OEC_Previews/sm-at601_preview/D4.3.cfm The wider the gap between the electrodes the weaker and less concentrated the signal becomes. “Electrical stimulation units use an electrical current to simulate the same electrical impulses that are activated during normal exercise. By passively activating the muscle, the body responds in much the same way as during normal exercise. By placing a pair of electrodes on the target muscle or muscle group, the unit can send electrical impulses through the skin to underlying nerves, stimulating the contraction and relaxation of the muscle in a rhythm similar to daily exercise. Electrical Stimulation can be used for two primary functions; strength training and muscle tone or pain control.” ref: http://www.unc.edu/~wrightke/how2.html
3) I’ve not received any certificate stating I’ve undergone formal training if that is what your asking. I’ve consulted with many pts, ots and doctors… Many who themselves had very little understanding if any. I took it upon myself to become educated via reading product documentation and books regarding the therapies and techniques. Bottom line is that I love my son very much and spent countless hours educating myself and experimenting on myself with the device to achieve the muscle contractions in the groups that presented with the imbalance on my son. I would never apply something to my child with poor understanding of how it would effect him. I also never received formal training on being a father but i believe I’m performing quite adequately. =)
4) As his father and knowing his capabilities on a day to day basis I still remember crying my eyes out the first time he was able to activly pull his sippy cup up to his mouth. Other AMC Families have kept up with Jace as we are actively communicating in the AMC Community; they are also aware of Jace’s progress. Formally my child has been seen and evaluated by many doctors (including Dr. Z and Dr. Van Bosse) in which they have medical records stating upper extremity presentation at birth. They measured passive ROM and documented complete lack of active ROM (Shriners in Shreveport and Dr. Gogola @ Shriners in Houston) up until I began Jace’s EStim. I also have numerous photographs and videos. For a lack of a better explination … Jace was unable to reach his mouth or lift his arms above his head. He now can. The strength gains are apparent based on observation. His OT from early steps also have a documented goals list where dates were recorded for setting the goal and then achieved.
5) Jace is seen by early steps here in Alexandria/Pineville La. The OT comes by once a week and works with Jace on life skills and simple task using his arms. They do not perform The JACE Method™ as described but can attest to the “what seems to be a meracle” progress his arms have made. The entirety of this procedure has been applied by me on a daily in hopes that one day my child will understand that his father went above and beyond with a diagnosis that wasn’t very well understood. A father that could not accept the current state in medical technology which presented no formal documented effort or method to promote active range of motion gains outside of surgery (very similar to the understanding of clubfoot before Dr. Ponseti came along) in children diagnosed with amyoplasia. It has only been recently that I’ve been contacted by AMC Family members to collect and present this information. I’ve shared bits and pieces over the last year with families in the AMC family group on facebook and they have either called, emailed or messaged how this method has been beneficial to their child.
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