NOTE: This message was originally in conference "INTERNET - E-MAIL AREA"
      and was copied here by Tom Mckeever.
From:         Tom Walter 
To:           Multiple recipients of list POLIO 
Date:         Mon, 31 Jul 1995 03:28:29 -0400
Subject:      TES
 
---
Ray--
 
Below is copy of an article about LOW-INTENSITY Electrical Stimulation -- not
the kind that causes muscle contraction -- the type I will be a subject of in
the pilot study starting later in August at Rancho Los Amigos Rehab in
Downey, CA. (USA)
 
tomincal@aol.com
_________________________________________
> THERAPEUTIC ELECTRICAL STIMULATION (TES)
>
> Ruth Wyler
> --------------------------------------------------------------------
Therapeutic electrical stimulation (TES) is an old technique with a  new
application: treatment of muscles weakened by the Post-Polio Syndrome. To
inform its readers, the newsletter staff sent its rolling reporter to learn
about this technique and to interview some of the people who are using it.
 
Low-level electrical stimulation, such as TES, has been used for years to
help heal broken bones and skin wounds not responding to conventional
treatment and treat selected cases of chronic pain. More recently it has been
used to treat patients with chronic neuromuscular disorders, such as cerebral
palsy, spina bifida, incomplete spinal cord injuries and stroke.
 
Dr. Karen Pape, Director of the Magee Clinic in Toronto is a pioneer in this
use of TES. Using TES, she has produced improvement in conditions previously
considered untreatable. Since its establishment in the mid-80s, over 2000
such patients now visit the Magee Clinic each year. They learn how to use its
TES program, to redevelop and strengthen their wasted muscles and to improve
their overall strength, coordination and well-being.
 
The use of TES to treat post-polio syndrome began in 1989 when a young
Canadian woman, Catherine Bell, was referred to Magee Clinic for treatment of
her muscle weakness. The improvement in her symptoms with TES therapy was so
marked that word spread. Dr. Pape
said in her letter to this reporter that approximately 120 polio survivors
have come through the clinic to date, and just under 100 of these are
currently on the program.
 
She emphasized that this technique does not treat the basic (initial) loss
due to polio. It is for the progressive muscle weakness seen years later and
the muscle atrophy from disuse due to injury or illness.
 
All referrals to the Clinic are made by a physician, and prospective clients
are prescreened by the Clinic before they come to Toronto. Approximately 50%
of those referred are turned down. Overweight is the most common reason for
refusal. In addition to making movement more stressful, excess body fat
decreases the amount of electrical current reaching the muscles during TES
and can make the treatment less effective.
 
 WHILE CLIENT SLEEPS
 
TES treatment involves placing electrodes at prescribed places on the surface
of the skin over muscle, and then stimulating the muscle with a small
electrical current for 5 to 8 hours a night while the client sleeps. Clients
can control the amount of stimulation. The electrical charge is painless and
is felt, if at all, as a slight "tickle." The stimulator is a
battery-operated device run on one 9-volt or three AA batteries, which need
to be replaced from every
few days to two weeks, acccording to the amount of power needed by the
individual.
 
TES is not used alone. It is a special technique added to an overall
rehabilitation program such as is used in most centers treating post-polio
syndrome. As at other centers, the Magee Clinic treatment program is
individually designed for each client. In addition to non-fatiguing exercise
to increase endurance and function, Dr. Magee
stresses the importance of proper nutrition to preserve muscle mass and
control weight. The program is designed essentially to be carried out at
home. As with all rehabilitation programs, it requires a long-term commitment
and self-discipline.
 
SOME REACTIONS
 
How do some of its users feel about it? After 2 years, Catherine Bell was
able to walk down a flight of steps again without fear of her leg collapsing.
She could take long walks with her husband and work again, although she
changed to a job less physically demanding. She feels she has regained at
least 75% of the strength and
stability she had before she had developed post-polio syndrome 4 years ago.
 
Anne Heaney of Manhattan, and Herbert Laster of Hastings-on Hudson, have had
similar experiences with 2 and 1 years' use, respectively. Both have improved
mobility but not to the level before the post-polio syndrome struck. However,
Ms. Heaney feels continuing leg
and arm improvement, even after 2 years of TES. Mr. Laster fears that while
he is stimulating several muscle groups, others continue to weaken.
 
DRS. HALSTEAD AND DRAKE TRYING TES
 
Two physicians have just recently begun using the TES program for their own
post-polio weakness. Dr. W.P. Drake, an internist in Oracle, Arizona, has
seen a slight improvement. Dr. Lauro Halstead, Director of the Post-Polio
Program at the National Rehabilitation
Hospital in Washington, DC, has seen no change in 7 months of TES. However,
he is not certain that he is a suitable candidate for this type of therapy.
 
TES RESULTS WITH MAGNETIC RESONANCE IMAGING SCANS
 
Although there is no agreement as to how TES achieves its effect, many
believe it acts by improving circulation to the muscle. Magnetic Resonance
Imaging (MRI) scans have shown actual growth of musculature with the TES
program. MRI is a technique that produces life-like imaging of muscle
involvement in the post-polio syndrome and enables doctors to measure the
effects of various therapies.
 
In terms of muscle function, Dr. Pape says the Magee program can usually
raise muscle strength 1 to 1.5 grades (on a scale of 0 to 5) over the course
of 1-1/2 to 2 years of treatment. Changes are usually noticed in 3 to 6
months. She states they have not found an effect on the overwhelming fatigue
experienced by some people with post-polio syndrome.
 
The Magee Clinic has been treating clients with post-polio syndrome for just
4 years. Results of the program are available for only a few individuals;
those for the whole treatment group are still being gathered. Each of the
three doctors interviewed, as well as Dr. Pape, expressed the need for
studies to answer questions such as: Who is
most likely to benefit from the TES program? What is the best treatment
regimen with TES? How long will the benefits persist?
 
Magee Clinic methods are being watched by rehabilitation centers throughout
the world. Few centers in the United States currently are offering TES for
treatment of post-polio syndrome. Additional information may be obtained
from:
 
The Magee Clinic
5160 Yonge St., Suite 505
North York, Ontario, Canada. M2N 6L9
(416) 733-1783
Fax (416) 733-1721
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